Individual
MS. COLLEEN MARIE STAFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5897 RT 281, LITTLE YORK, NY 13087
(607) 423-6465
Mailing address
5897 STATE RT. 281, LITTLE YORK, NY 13077
(607) 423-6465
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
1207621
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01933848
—
NY
Enumeration date
02/21/2008
Last updated
02/21/2008
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