Provider Demographics
NPI:1427309640
Name:VISCARRA, COLLEEN A (NP-C)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:A
Last Name:VISCARRA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 EMERALD STREET
Mailing Address - Street 2:WRENTHAM DEVELOPMENTAL CENTER
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093
Mailing Address - Country:US
Mailing Address - Phone:508-384-5525
Mailing Address - Fax:
Practice Address - Street 1:131 EMERALD ST
Practice Address - Street 2:WRENTHAM DEVELOPMENTAL CENTER
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1902
Practice Address - Country:US
Practice Address - Phone:508-384-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN260410363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care