Provider Demographics
NPI:1770873036
Name:GOTHMAN, COLLEEN AMELIA (RN)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:AMELIA
Last Name:GOTHMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 W PLANO PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8466
Mailing Address - Country:US
Mailing Address - Phone:214-483-9300
Mailing Address - Fax:214-483-9301
Practice Address - Street 1:7000 W PLANO PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8466
Practice Address - Country:US
Practice Address - Phone:214-483-9300
Practice Address - Fax:214-483-9301
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX762474163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX762474OtherTEXAS BOARD OF NURSING