Basic Information
| Provider Information | |||||||||
| NPI: | 1356431050 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REILLY | ||||||||
| FirstName: | COLLEEN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | RN, APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 COOPER PLZ | ||||||||
| Address2: | SUITE 502 | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8569687433 | ||||||||
| FaxNumber: | 8569688366 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 PLAZA DR | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080802747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562704040 | ||||||||
| FaxNumber: | 8562704044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 06/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NR79808 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | NN79808 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | RN322533L | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.