Provider Demographics
NPI:1497823744
Name:COLLIEN, WENDA SUZANNE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:WENDA
Middle Name:SUZANNE
Last Name:COLLIEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:410-573-9530
Mailing Address - Fax:410-573-9568
Practice Address - Street 1:2000 MEDICAL PKWY
Practice Address - Street 2:STE. 304
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3742
Practice Address - Country:US
Practice Address - Phone:410-573-9530
Practice Address - Fax:410-573-9568
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR124400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCY310015OtherBCBS
MD239396Y5ZOtherMEDICARE
MD239396ZDWSOtherMEDICARE