Provider Demographics
NPI:1982138517
Name:COLDREN, GEORGE III (RN)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:COLDREN
Suffix:III
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2105
Mailing Address - Country:US
Mailing Address - Phone:215-859-1285
Mailing Address - Fax:
Practice Address - Street 1:1108 E WILLOW GROVE AVE
Practice Address - Street 2:
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-7663
Practice Address - Country:US
Practice Address - Phone:215-233-6226
Practice Address - Fax:215-836-0300
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN647762163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse