Provider Demographics
NPI:1205689106
Name:MCCOLLUM, MARA (CD(DONA))
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DANIELLE CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-1449
Mailing Address - Country:US
Mailing Address - Phone:858-371-4664
Mailing Address - Fax:
Practice Address - Street 1:7 DANIELLE CT
Practice Address - Street 2:
Practice Address - City:LAWRENCE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08648-1449
Practice Address - Country:US
Practice Address - Phone:858-371-4664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0450731642374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula