Provider Demographics
NPI:1629732102
Name:MEULEMAN, COLBY
Entity Type:Individual
Prefix:
First Name:COLBY
Middle Name:
Last Name:MEULEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 W HIGH ST STE 240
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-5906
Mailing Address - Country:US
Mailing Address - Phone:419-996-2686
Mailing Address - Fax:419-996-2687
Practice Address - Street 1:770 W HIGH ST STE 240
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5906
Practice Address - Country:US
Practice Address - Phone:419-996-2686
Practice Address - Fax:419-996-2687
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0030058363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner