MEDICARE: MS. ALBERTHA COLEY RN

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	163W00000X	Registered Nurse	238750	NY

General Provider Information

NPI Number	:	1558550293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALBERTHA COLEY RN

Provider Business Mailing Address
First Line	:	12608 SUMMERWOOD DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-1755
Country	:	US
Telephone Number	:	301-572-5452
Fax Number	:	301-572-5224

Provider Business Practice Location Address
First Line	:	2160 HOLLAND AVE
Second Line	:	# B6
City	:	BRONX
State	:	NY
Zip	:	10462-1779
Country	:	US
Telephone Number	:	917-576-7274
Fax Number	:	301-572-5224

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

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	10/19/2007

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