Healthcare Provider Details

I. General information

NPI: 1235548181
Provider Name (Legal Business Name): GRISEL COLON RN, BSN ,CM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 HONEY HILL DR
WAUCONDA IL
60084-1712
US

IV. Provider business mailing address

114 HONEY HILL
WAUCONDA IL
60084
US

V. Phone/Fax

Practice location:
  • Phone: 773-320-1035
  • Fax: 312-347-0061
Mailing address:
  • Phone: 773-320-1035
  • Fax: 312-347-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041211547
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number041211547
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number041211547
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number041211547
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number041211547
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number041211547
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number041211547
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: