Provider Demographics
NPI:1699023556
Name:YACONO, COLLEEN MARIE (RN)
Entity Type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:MARIE
Last Name:YACONO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 GLENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-2844
Mailing Address - Country:US
Mailing Address - Phone:585-545-0712
Mailing Address - Fax:
Practice Address - Street 1:70 GLENBROOK RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-2844
Practice Address - Country:US
Practice Address - Phone:585-545-0712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY587922163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse