Provider Demographics
NPI:1851775399
Name:MCCOLLEY, DANA M (CNP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:MCCOLLEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:419-724-8368
Mailing Address - Fax:419-724-8375
Practice Address - Street 1:5800 PARK CENTER CT
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-0710
Practice Address - Country:US
Practice Address - Phone:419-724-8368
Practice Address - Fax:419-724-8375
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA:17642-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0151038Medicaid
OHH435870Medicare PIN
OH3613091OtherMEDICARE GRP PTAN
OH1407880909OtherGROUP NPI