Provider Demographics
NPI:1376320192
Name:COLESON, CLAIRESSA LEE
Entity Type:Individual
Prefix:
First Name:CLAIRESSA
Middle Name:LEE
Last Name:COLESON
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 1:195 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-9224
Mailing Address - Country:US
Mailing Address - Phone:716-483-4411
Mailing Address - Fax:
Practice Address - Street 1:195 MARTIN RD
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-9224
Practice Address - Country:US
Practice Address - Phone:716-483-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY647862163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse