Provider Demographics
NPI:1073656864
Name:KUCHARCZUK, COLLEEN RENEE (CRNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:RENEE
Last Name:KUCHARCZUK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:RENEE
Other - Last Name:SCHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:3 RHOADS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-662-2475
Mailing Address - Fax:215-615-3732
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:3 RHOADS
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-662-2475
Practice Address - Fax:215-615-3732
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009308363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health