Provider Demographics
NPI:1558465153
Name:DE MARRIAS, COLETTE MARIE (WHNPC FNPC)
Entity Type:Individual
Prefix:MS
First Name:COLETTE
Middle Name:MARIE
Last Name:DE MARRIAS
Suffix:
Gender:F
Credentials:WHNPC FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 HOMESTEAD RD NE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1437
Mailing Address - Country:US
Mailing Address - Phone:505-872-4700
Mailing Address - Fax:505-872-4709
Practice Address - Street 1:5310 HOMESTEAD RD NE
Practice Address - Street 2:SUITE 301
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1437
Practice Address - Country:US
Practice Address - Phone:505-872-4700
Practice Address - Fax:505-872-4709
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR46867363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
C97818Medicare UPIN
NM2108003Medicare ID - Type Unspecified