Provider Demographics
NPI:1760913792
Name:RALPH, COLLEEN (NP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:RALPH
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 1:12001 FERRARA AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-4706
Mailing Address - Country:US
Mailing Address - Phone:301-946-6623
Mailing Address - Fax:301-946-1107
Practice Address - Street 1:12001 FERRARA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906
Practice Address - Country:US
Practice Address - Phone:301-946-6623
Practice Address - Fax:301-946-1107
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR187958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily