Provider Demographics
NPI:1679753172
Name:ALTOMAR, COLETTE MILLIE (RN, PHN)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:MILLIE
Last Name:ALTOMAR
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 PACKARD AVE STE 100
Mailing Address - Street 2:PO BOX 2320
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901
Mailing Address - Country:US
Mailing Address - Phone:530-749-6767
Mailing Address - Fax:530-749-6397
Practice Address - Street 1:5730 PACKARD AVE
Practice Address - Street 2:STE 100
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901
Practice Address - Country:US
Practice Address - Phone:530-749-6767
Practice Address - Fax:530-749-6397
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA182593163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health