Provider Demographics
NPI:1689875098
Name:REILLY, LORETTA COLFORD (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:COLFORD
Last Name:REILLY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:302 KEATLEY DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-5131
Mailing Address - Country:US
Mailing Address - Phone:856-802-6407
Mailing Address - Fax:215-590-6301
Practice Address - Street 1:34TH ST AND CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-590-0789
Practice Address - Fax:215-590-6301
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN251317L163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics