Provider Demographics
NPI:1609178227
Name:SPATOLA, COLLEEN WHALEN
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:WHALEN
Last Name:SPATOLA
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 1:471 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-2501
Mailing Address - Country:US
Mailing Address - Phone:607-786-2021
Mailing Address - Fax:607-748-8262
Practice Address - Street 1:471 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-2501
Practice Address - Country:US
Practice Address - Phone:607-786-2021
Practice Address - Fax:607-748-8262
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY490540163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse