Provider Demographics
NPI:1427388370
Name:PELLOWSKI, COLETTE ROULEAU (NP)
Entity Type:Individual
Prefix:MRS
First Name:COLETTE
Middle Name:ROULEAU
Last Name:PELLOWSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:COLETTE
Other - Middle Name:
Other - Last Name:ROULEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2299 MOWRY AVE
Mailing Address - Street 2:SUITE 3-C
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1621
Mailing Address - Country:US
Mailing Address - Phone:510-248-1470
Mailing Address - Fax:510-796-5198
Practice Address - Street 1:2299 MOWRY AVE
Practice Address - Street 2:SUITE 3-C
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1621
Practice Address - Country:US
Practice Address - Phone:510-248-1470
Practice Address - Fax:510-796-5198
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP13196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily