Provider Demographics
NPI:1669700092
Name:RAGIN, COLLETTE SEYMOAN (LPN)
Entity type:Individual
Prefix:MRS
First Name:COLLETTE
Middle Name:SEYMOAN
Last Name:RAGIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 TOMPKINS AVE
Mailing Address - Street 2:3A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-6882
Mailing Address - Country:US
Mailing Address - Phone:347-495-3261
Mailing Address - Fax:
Practice Address - Street 1:171 TOMPKINS AVE
Practice Address - Street 2:3A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-6882
Practice Address - Country:US
Practice Address - Phone:347-495-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298564164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse