Provider Demographics
NPI:1992202691
Name:WESLEY, COLLEEN (CNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:WESLEY
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 1:1810 MACKENZIE DR FL 2
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2967
Mailing Address - Country:US
Mailing Address - Phone:614-273-2250
Mailing Address - Fax:614-273-2255
Practice Address - Street 1:477 COOPER RD STE 480
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8095
Practice Address - Country:US
Practice Address - Phone:614-823-7135
Practice Address - Fax:614-823-7137
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023211363LF0000X
OHRN.268857163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0321067Medicaid