Healthcare Provider Details

I. General information

NPI: 1134881287
Provider Name (Legal Business Name): COLLEEN ILONA FRANK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 COLONEL GLENN HWY 117 HEALTH SCIENCES BLDG
DAYTON OH
45435-0001
US

IV. Provider business mailing address

223 MEDFORD ST
DAYTON OH
45410-2116
US

V. Phone/Fax

Practice location:
  • Phone: 937-775-3458
  • Fax:
Mailing address:
  • Phone: 480-812-5286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number109831
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: