Provider Demographics
NPI:1538437330
Name:COLCORD, CHRISTIN MARIE (RN)
Entity type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:MARIE
Last Name:COLCORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-4393
Mailing Address - Country:US
Mailing Address - Phone:530-899-2255
Mailing Address - Fax:
Practice Address - Street 1:1626 E LASSEN AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7875
Practice Address - Country:US
Practice Address - Phone:530-961-2698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA794165163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse