MEDICARE: DENISE COLON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	4703087197	MI

General Provider Information

NPI Number	:	1093101867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE COLON

Provider Business Mailing Address
First Line	:	8181 N WAYNE RD APT 2016
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-1328
Country	:	US
Telephone Number	:	734-444-6873
Fax Number	:

Provider Business Practice Location Address
First Line	:	8181 N WAYNE RD APT 2016
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-1328
Country	:	US
Telephone Number	:	734-444-6873
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2015
Last Update Date	:	04/08/2015

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Directions to “ DENISE COLON ” Practice Location

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