Provider Demographics
NPI:1235514050
Name:FERRIS, COLEEN (RN)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:
Last Name:FERRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-4541
Mailing Address - Country:US
Mailing Address - Phone:360-581-5234
Mailing Address - Fax:360-669-0211
Practice Address - Street 1:1221 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4541
Practice Address - Country:US
Practice Address - Phone:360-581-5234
Practice Address - Fax:360-669-0211
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00128545163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse