Provider Demographics
NPI:1447441829
Name:COLUCCI, PATRICIA (RN, C, CCM)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:COLUCCI
Suffix:
Gender:F
Credentials:RN, C, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 495
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-0495
Mailing Address - Country:US
Mailing Address - Phone:973-459-9966
Mailing Address - Fax:973-927-1350
Practice Address - Street 1:57 CRENSHAW DR
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-4721
Practice Address - Country:US
Practice Address - Phone:973-459-9966
Practice Address - Fax:973-927-1350
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO08498400163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management