Provider Demographics
NPI:1609436344
Name:COLON, PHALON M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:PHALON
Middle Name:M
Last Name:COLON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 MARNE ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-2515
Mailing Address - Country:US
Mailing Address - Phone:585-713-0112
Mailing Address - Fax:
Practice Address - Street 1:290 MARNE ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-2515
Practice Address - Country:US
Practice Address - Phone:585-713-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-15
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301802164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse