Healthcare Provider Details

I. General information

NPI: 1689719387
Provider Name (Legal Business Name): JANICE C. COLWELL RN,MS,CWOCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S. MARYLAND AVE MC6043
CHICAGO IL
60637
US

IV. Provider business mailing address

1335 S PRAIRIE AVE #1507
CHICAGO IL
60605-3121
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-9371
  • Fax: 773-834-1779
Mailing address:
  • Phone: 312-945-0026
  • Fax: 773-834-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: