Provider Demographics
NPI:1548405483
Name:PROROK, COLLEEN MARIE (RN, MSN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARIE
Last Name:PROROK
Suffix:
Gender:F
Credentials:RN, MSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CARTER MILL WAY
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-2243
Mailing Address - Country:US
Mailing Address - Phone:301-774-7279
Mailing Address - Fax:301-774-7279
Practice Address - Street 1:2000 CARTER MILL WAY
Practice Address - Street 2:
Practice Address - City:BROOKEVILLE
Practice Address - State:MD
Practice Address - Zip Code:20833-2243
Practice Address - Country:US
Practice Address - Phone:301-774-7279
Practice Address - Fax:301-774-7279
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR052436163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant