Provider Demographics
NPI:1760673107
Name:COLON-MARIN, JEANNETTE ELISE (MD)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:ELISE
Last Name:COLON-MARIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WALL ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2585
Mailing Address - Country:US
Mailing Address - Phone:219-707-5772
Mailing Address - Fax:219-707-5758
Practice Address - Street 1:401 WALL ST UNIT A
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2585
Practice Address - Country:US
Practice Address - Phone:219-707-5772
Practice Address - Fax:219-707-5758
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17073207V00000X
IN01075122A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology