Provider Demographics
NPI:1437569407
Name:COLEGROVE, MANDY (CRNP)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:COLEGROVE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-3027
Mailing Address - Country:US
Mailing Address - Phone:540-316-5000
Mailing Address - Fax:
Practice Address - Street 1:253 VETERANS DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3076
Practice Address - Country:US
Practice Address - Phone:540-316-5930
Practice Address - Fax:540-316-5585
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR154963363LP2300X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care