Provider Demographics
NPI:1942841135
Name:DECOLA-ARSENAULT, COLLEEN MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MICHELLE
Last Name:DECOLA-ARSENAULT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7228
Mailing Address - Country:US
Mailing Address - Phone:207-797-5753
Mailing Address - Fax:207-797-9572
Practice Address - Street 1:92 CAMPUS DR STE C
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7133
Practice Address - Country:US
Practice Address - Phone:207-797-5753
Practice Address - Fax:207-797-9571
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPAN1970363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant