Provider Demographics
NPI:1326322058
Name:IGNASZEWSKI, COLLEEN BERRY
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:BERRY
Last Name:IGNASZEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BIG FLATS
Mailing Address - State:NY
Mailing Address - Zip Code:14814-9707
Mailing Address - Country:US
Mailing Address - Phone:607-795-2552
Mailing Address - Fax:607-795-2555
Practice Address - Street 1:543 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BIG FLATS
Practice Address - State:NY
Practice Address - Zip Code:14814-9707
Practice Address - Country:US
Practice Address - Phone:607-795-2552
Practice Address - Fax:607-795-2555
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348813163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse