Individual
CLOVER MARJORIE COLONEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
1040 S CHURCH ST, BURLINGTON, NC 27215-5046
(336) 222-8052
(336) 222-8091
Mailing address
1040 S CHURCH ST, BURLINGTON, NC 27215-5046
(336) 222-8052
(336) 222-8091
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7795167
—
NC
Enumeration date
08/20/2008
Last updated
10/25/2019
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