Provider Demographics
NPI:1841430832
Name:MESEROLL, COLLEEN (PNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MESEROLL
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 LOMBARDI CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-6793
Mailing Address - Country:US
Mailing Address - Phone:707-547-2222
Mailing Address - Fax:707-547-2229
Practice Address - Street 1:962 SEBASTOPOL RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-6829
Practice Address - Country:US
Practice Address - Phone:707-547-2222
Practice Address - Fax:707-547-2229
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8644363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics