Healthcare Provider Details

I. General information

NPI: 1174565204
Provider Name (Legal Business Name): COLLEEN B FLEMING-DAMON MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 READE PL VASSAR BROTHERS MEDICAL CENTER
POUGHKEEPSIE NY
12601-3947
US

IV. Provider business mailing address

PO BOX 5506
CULVER CITY CA
90231-5506
US

V. Phone/Fax

Practice location:
  • Phone: 845-454-8500
  • Fax:
Mailing address:
  • Phone: 845-744-3498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberF303827-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: