Provider Demographics
NPI:1881652741
Name:MALONEY-HESSER, COLLEEN (NP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MALONEY-HESSER
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 1:20 HOPE AVE
Mailing Address - Street 2:SUITE G10
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-2721
Mailing Address - Country:US
Mailing Address - Phone:781-647-6920
Mailing Address - Fax:781-891-0056
Practice Address - Street 1:20 HOPE AVE
Practice Address - Street 2:SUITE G10
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2721
Practice Address - Country:US
Practice Address - Phone:781-647-6920
Practice Address - Fax:781-891-0056
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA142278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0390101Medicaid
MANP161102Medicare PIN
MA0390101Medicaid
MANP1611Medicare ID - Type Unspecified