Provider Demographics
NPI:1073963153
Name:HUNTER-GAUDREAU, COLLEEN NICOLE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:NICOLE
Last Name:HUNTER-GAUDREAU
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 ROWLEY DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-1629
Mailing Address - Country:US
Mailing Address - Phone:512-219-0853
Mailing Address - Fax:
Practice Address - Street 1:16040 PARK VALLEY DR STE 111
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3596
Practice Address - Country:US
Practice Address - Phone:512-248-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily