Provider Demographics
NPI:1558108944
Name:ANDERSON, COLLEEN SONYA (DOULA)
Entity type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:SONYA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:SONYA
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOULA
Mailing Address - Street 1:79 WASHINGTON ST APT 301
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1032
Mailing Address - Country:US
Mailing Address - Phone:973-752-6776
Mailing Address - Fax:
Practice Address - Street 1:79 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1047
Practice Address - Country:US
Practice Address - Phone:973-752-6776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty