Healthcare Provider Details

I. General information

NPI: 1295516037
Provider Name (Legal Business Name): COLLEEN MADONIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1097 MADRID DR
AKRON OH
44313-5237
US

IV. Provider business mailing address

1097 MADRID DR
AKRON OH
44313-5237
US

V. Phone/Fax

Practice location:
  • Phone: 330-701-8201
  • Fax:
Mailing address:
  • Phone: 330-701-8201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN.267139
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.0035108
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: