Provider Demographics
NPI:1962793810
Name:NANTON, COLLEEN INGRID RITA (PA)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:INGRID RITA
Last Name:NANTON
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Gender:F
Credentials:PA
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Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:301-645-1523
Mailing Address - Fax:301-645-6812
Practice Address - Street 1:3460 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3240
Practice Address - Country:US
Practice Address - Phone:301-645-1523
Practice Address - Fax:301-645-6812
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2017-02-21
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Provider Licenses
StateLicense IDTaxonomies
MDC0004446363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical