Provider Demographics
NPI:1457313751
Name:COLELLA, CHRISTINE L (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:COLELLA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:L
Other - Last Name:FRAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:285 PIPELINE RD
Mailing Address - Street 2:
Mailing Address - City:NEWVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17241-8729
Mailing Address - Country:US
Mailing Address - Phone:717-706-5494
Mailing Address - Fax:
Practice Address - Street 1:285 PIPELINE RD
Practice Address - Street 2:
Practice Address - City:NEWVILLE
Practice Address - State:PA
Practice Address - Zip Code:17241-8729
Practice Address - Country:US
Practice Address - Phone:717-706-5494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN670502367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010222176Medicaid
PA437297P1KMedicare PIN