Provider Demographics
NPI:1760780829
Name:BOND, COLLEEN D (NP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:D
Last Name:BOND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CENTER DRIVE ROOM 4-3752
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-3725
Mailing Address - Country:US
Mailing Address - Phone:240-858-3725
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DRIVE
Practice Address - Street 2:BUILDING 10 ROOM 4-3752
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20016-2001
Practice Address - Country:US
Practice Address - Phone:240-858-3725
Practice Address - Fax:301-480-5103
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1011754363L00000X
MDR188189363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1760780829Medicaid