Provider Demographics
NPI:1053803353
Name:COLELLA NIESEN, TARA IRENE (NP)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:IRENE
Last Name:COLELLA NIESEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 789967
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-9967
Mailing Address - Country:US
Mailing Address - Phone:484-622-7395
Mailing Address - Fax:484-622-7399
Practice Address - Street 1:1330 POWELL ST STE 507
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3352
Practice Address - Country:US
Practice Address - Phone:484-622-7940
Practice Address - Fax:484-622-7950
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP018653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily