Provider Demographics
NPI:1639354772
Name:PHALEN, COLLEEN A (NPI)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:A
Last Name:PHALEN
Suffix:
Gender:F
Credentials:NPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5151
Mailing Address - Country:US
Mailing Address - Phone:530-885-5177
Mailing Address - Fax:
Practice Address - Street 1:1111 HIGH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5151
Practice Address - Country:US
Practice Address - Phone:530-885-5177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA355373CP163W00000X
390200000X
CA18390363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program