Provider Demographics
NPI:1184385544
Name:COLUMBO, MARIA LUISA (CCRN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LUISA
Last Name:COLUMBO
Suffix:
Gender:F
Credentials:CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 POPLAR CT
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-9411
Mailing Address - Country:US
Mailing Address - Phone:845-248-2932
Mailing Address - Fax:
Practice Address - Street 1:25 POPLAR CT
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-9411
Practice Address - Country:US
Practice Address - Phone:845-248-2932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY686903-01163WH0200X, 163WP0200X, 163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics