Provider Demographics
NPI:1952396442
Name:COLONELLO, KELLY A (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:COLONELLO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Mailing Address - Street 1:1760 E RIVER RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5877
Mailing Address - Country:US
Mailing Address - Phone:520-519-7775
Mailing Address - Fax:520-519-7760
Practice Address - Street 1:10197 N 92ND ST
Practice Address - Street 2:STE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4560
Practice Address - Country:US
Practice Address - Phone:480-993-2950
Practice Address - Fax:480-993-2957
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2009-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZAP2071363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ129467Medicare PIN
P06970Medicare UPIN