Provider Demographics
NPI:1235548181
Name:COLON, GRISEL (RN, BSN ,CM)
Entity Type:Individual
Prefix:MS
First Name:GRISEL
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:RN, BSN ,CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 HONEY HILL
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084
Mailing Address - Country:US
Mailing Address - Phone:773-320-1035
Mailing Address - Fax:312-347-0061
Practice Address - Street 1:114 HONEY HILL DR
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-1712
Practice Address - Country:US
Practice Address - Phone:773-320-1035
Practice Address - Fax:312-347-0061
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041211547163W00000X, 163WA0400X, 163WC0400X, 163WG0600X, 163WP0000X, 163WP0808X, 163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent