Basic Information
| Provider Information | |||||||||
| NPI: | 1174991434 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREWIN | ||||||||
| FirstName: | COLLEEN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HASSELL | ||||||||
| OtherFirstName: | COLLEEN | ||||||||
| OtherMiddleName: | R | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 333 W MAIN ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | SAXONBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 160562254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243528422 | ||||||||
| FaxNumber: | 7243528426 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 W MAIN ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | SAXONBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 160562254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243528422 | ||||||||
| FaxNumber: | 7243528426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2015 | ||||||||
| LastUpdateDate: | 10/09/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP016827 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 13945564 | 01 | PA | CAQH | OTHER | 103233519- | 05 | PA | MEDICAID |