Provider Demographics
NPI:1467207506
Name:COELLO, DARLENE MICHELLE
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:MICHELLE
Last Name:COELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 STEWARTS KNOB DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-4400
Mailing Address - Country:US
Mailing Address - Phone:910-260-1825
Mailing Address - Fax:
Practice Address - Street 1:10941 RAVEN RIDGE RD STE 103
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6487
Practice Address - Country:US
Practice Address - Phone:919-870-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019956363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner