Provider Demographics
NPI:1942471164
Name:JOHNSON, COLLEEN E
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 RIDGEWAY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4145
Mailing Address - Country:US
Mailing Address - Phone:585-720-1550
Mailing Address - Fax:585-720-1553
Practice Address - Street 1:2440 RIDGEWAY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4145
Practice Address - Country:US
Practice Address - Phone:585-720-1550
Practice Address - Fax:585-720-1553
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY520245-1163W00000X
NY335538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse