Provider Demographics
NPI:1447439120
Name:HARRISON, COLLEEN A (PA-C)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:A
Last Name:HARRISON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 N FRANCISCO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3611
Mailing Address - Country:US
Mailing Address - Phone:773-271-2225
Mailing Address - Fax:773-271-1145
Practice Address - Street 1:5115 N FRANCISCO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3611
Practice Address - Country:US
Practice Address - Phone:773-271-2225
Practice Address - Fax:773-271-1145
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85003085363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant