Provider Demographics
NPI:1679718365
Name:MARTIN, COLLEEN DUFOUR (CRNA)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:DUFOUR
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-4431
Mailing Address - Country:US
Mailing Address - Phone:732-614-6759
Mailing Address - Fax:
Practice Address - Street 1:655 SHREWSBURY AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4179
Practice Address - Country:US
Practice Address - Phone:732-614-6759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007417367500000X
IL041.322892163W00000X
NJ26NJ00470500367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse