Organization Name: | MARRI PORTIA COLLOM FNP PLLC |
NPI Number: | 1245634997 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARRI COLLOM (FNP/ PRACTICE OWNER) |
Mailing Address: | 350 East St #1307 Nederland |
State: | CO US |
Postal Code: | 804665001 |
Phone Number: | 3037753401 |
Fax Number: | |
NPI Enumeration Date: | 10/09/2014 |
NPI Last Update Date: | 03/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | APN.0990991-NP |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |