Provider Demographics
NPI:1225095409
Name:COLLEY, TERESA MICHELE (ARNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MICHELE
Last Name:COLLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1215 N MCDONALD RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1557
Mailing Address - Country:US
Mailing Address - Phone:509-924-1950
Mailing Address - Fax:509-924-1950
Practice Address - Street 1:205 W INDIANA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4763
Practice Address - Country:US
Practice Address - Phone:509-326-6474
Practice Address - Fax:509-326-2565
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-29
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP30005869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9640517Medicaid
WA0156916OtherLABOR AND INDUSTRIES
WA9640517Medicaid