Individual
MRS. COLLEEN ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
296 MARANATHA WAY, DELANSON, NY 12053-1730
(518) 491-3898
Mailing address
296 MARANATHA WAY, DELANSON, NY 12053-1730
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
323056
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
323056
LPN LICENSE
NY
01
—
632542316
DRIVERS LICENSE
NY
Enumeration date
08/31/2018
Last updated
08/31/2018
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