Healthcare Provider Details

I. General information

NPI: 1639377419
Provider Name (Legal Business Name): COLLEEN JOYCE POMARO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 EAST MARKET ST NORTHMAR III PAUL M ROSMAN DO
WARREN OH
44484
US

IV. Provider business mailing address

15 WILDA AVENUE
YOUNGSTOWN OH
44512-2921
US

V. Phone/Fax

Practice location:
  • Phone: 330-856-3104
  • Fax: 330-856-3056
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP07679
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN123065
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: