MEDICARE: CLOVER MARJORIE COLONEL R.N.

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	225000000X	Orthotic Fitter
2	335E00000X	Prosthetic/Orthotic Supplier		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831346964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLOVER MARJORIE COLONEL R.N.

Provider Business Mailing Address
First Line	:	1040 S CHURCH ST
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-5046
Country	:	US
Telephone Number	:	336-222-8052
Fax Number	:	336-222-8091

Provider Business Practice Location Address
First Line	:	1040 S CHURCH ST
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-5046
Country	:	US
Telephone Number	:	336-222-8052
Fax Number	:	336-222-8091

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

Provider Enumeration Date	:	08/20/2008
Last Update Date	:	10/25/2019

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