Provider Demographics
NPI:1861632655
Name:COLOZZI, ROBERT EMIL (LPN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EMIL
Last Name:COLOZZI
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9434 LEBEAU LN
Mailing Address - Street 2:
Mailing Address - City:BREWERTON
Mailing Address - State:NY
Mailing Address - Zip Code:13029-9714
Mailing Address - Country:US
Mailing Address - Phone:315-676-7978
Mailing Address - Fax:
Practice Address - Street 1:9434 LEBEAU LANE
Practice Address - Street 2:
Practice Address - City:BREWERTON
Practice Address - State:NY
Practice Address - Zip Code:13029-9714
Practice Address - Country:US
Practice Address - Phone:315-676-7978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281251-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse