Provider Demographics
NPI:1366540874
Name:CASTELEIN, COLLEEN SARA (RN, CNP)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:SARA
Last Name:CASTELEIN
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:SARA
Other - Last Name:DVORAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNP
Mailing Address - Street 1:11100 EUCLID AVE
Mailing Address - Street 2:SCC 1200
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:216-844-1006
Mailing Address - Fax:216-844-1721
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:SCC 1200
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-1006
Practice Address - Fax:216-844-1721
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-08842363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0056200Medicaid
OH0056200Medicaid