Provider Demographics
NPI:1881650158
Name:COLON, OLGA IRIS (APRN)
Entity Type:Individual
Prefix:MS
First Name:OLGA
Middle Name:IRIS
Last Name:COLON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 GILLETT ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2637
Mailing Address - Country:US
Mailing Address - Phone:860-247-2500
Mailing Address - Fax:860-247-2800
Practice Address - Street 1:60 GILLETT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2367
Practice Address - Country:US
Practice Address - Phone:860-247-2500
Practice Address - Fax:860-247-2800
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT231039OtherPREFERRED ONE
CT400003016CT01OtherBLUE CROSS/BLUE SHIELD
CTP33522458OtherOXFORD
CT004243507Medicaid
CT400003016CT02OtherBLUE CROSS/BLUE CARE
CT043678785OtherAMALGAMATED LIFE, CHN
CT2V4998OtherHEALTHNET
CT004243490Medicaid
CT008044860Medicaid
CT030160OtherCONNECTICARE
CT00424350700OtherBLUE CARE FAMILY
CT231039OtherPREFERRED ONE
CT500001291Medicare ID - Type Unspecified