Provider Demographics
NPI:1689719387
Name:COLWELL, JANICE C (RN,MS,CWOCN)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:C
Last Name:COLWELL
Suffix:
Gender:F
Credentials:RN,MS,CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1335 S PRAIRIE AVE
Mailing Address - Street 2:#1507
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3121
Mailing Address - Country:US
Mailing Address - Phone:312-945-0026
Mailing Address - Fax:773-834-1779
Practice Address - Street 1:5841 S. MARYLAND AVE
Practice Address - Street 2:MC6043
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:773-702-9371
Practice Address - Fax:773-834-1779
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL163WE0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
K08732Medicare UPIN