Provider Demographics
NPI:1962584318
Name:ACEVEDO, COLEEN SOMMERS (CRNP)
Entity type:Individual
Prefix:MRS
First Name:COLEEN
Middle Name:SOMMERS
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 SOUTH SEVENTH AVE
Practice Address - Street 2:SUITE #340
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611
Practice Address - Country:US
Practice Address - Phone:610-988-4260
Practice Address - Fax:610-988-4261
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN1350942L207Q00000X
PAUP005457-B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102201234Medicaid