Provider Demographics
NPI:1407169626
Name:ECCLESTON, COLLEEN LOUISE (RN)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:LOUISE
Last Name:ECCLESTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:COLLEEN
Other - Middle Name:LOUISE
Other - Last Name:EARSING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:227 THORN AVE
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2600
Mailing Address - Country:US
Mailing Address - Phone:716-662-2040
Mailing Address - Fax:716-662-0019
Practice Address - Street 1:34 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1326
Practice Address - Country:US
Practice Address - Phone:585-786-0220
Practice Address - Fax:585-786-3631
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY415322163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health