Provider Demographics
NPI:1104035609
Name:ZAMAGNI, COLLEEN (NP)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:ZAMAGNI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 HALE STREET
Mailing Address - Street 2:CALLAHAN CENTER, OFFICE 118
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-232-2104
Mailing Address - Fax:978-998-8004
Practice Address - Street 1:376 HALE STREET
Practice Address - Street 2:CALLAHAN CENTER, OFFICE 118
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-232-2104
Practice Address - Fax:978-998-8004
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208728363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084225AMedicaid
MAS400256501OtherMEDICARE PTAN