Provider Demographics
NPI:1184114233
Name:CILISKE, COLLEEN (DNP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:CILISKE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 GEMINI ST STE 128
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2746
Mailing Address - Country:US
Mailing Address - Phone:281-218-9515
Mailing Address - Fax:281-218-9534
Practice Address - Street 1:1002 GEMINI ST STE 128
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058
Practice Address - Country:US
Practice Address - Phone:281-218-9515
Practice Address - Fax:281-218-9534
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX855146163W00000X
TXAP137764367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX855146OtherLICENSE