Provider Demographics
NPI:1912620550
Name:SLEVIN, COLLEEN MARIE (MSN, WHNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:MARIE
Last Name:SLEVIN
Suffix:
Gender:F
Credentials:MSN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2296 OPITZ BLVD STE 440
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3355
Mailing Address - Country:US
Mailing Address - Phone:443-844-8601
Mailing Address - Fax:703-878-3933
Practice Address - Street 1:2296 OPITZ BLVD STE 440
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3355
Practice Address - Country:US
Practice Address - Phone:703-878-0740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0024185581363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program