Provider Demographics
NPI:1154303477
Name:MCCOLLUM, GERALDINE ROSE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:ROSE
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9680 SPENCER MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-3436
Mailing Address - Country:US
Mailing Address - Phone:619-203-1654
Mailing Address - Fax:
Practice Address - Street 1:9680 SPENCER MOUNTAIN RD
Practice Address - Street 2:S
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-3436
Practice Address - Country:US
Practice Address - Phone:619-203-1654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13044363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABI370ZMedicare UPIN