Provider Demographics
NPI:1598140709
Name:MCDERMOTT, COLLEEN J
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:J
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:COLLEEN
Other - Middle Name:J
Other - Last Name:HARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:335 LILY AVE
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-2126
Mailing Address - Country:US
Mailing Address - Phone:607-661-2422
Mailing Address - Fax:
Practice Address - Street 1:335 LILY AVE
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-2126
Practice Address - Country:US
Practice Address - Phone:607-661-2422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306289-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse