Provider Demographics
NPI:1992432272
Name:COLEY, NICHOLAS BRUCE
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:BRUCE
Last Name:COLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 5TH ST SE APT 12
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-5443
Mailing Address - Country:US
Mailing Address - Phone:202-554-2199
Mailing Address - Fax:
Practice Address - Street 1:3423 5TH ST SE APT 12
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-5443
Practice Address - Country:US
Practice Address - Phone:202-554-2199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant