Provider Demographics
NPI:1720302912
Name:GOLICKI, COLLEEN ELIZABETH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ELIZABETH
Last Name:GOLICKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:ELIZABETH
Other - Last Name:MCMAHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:71 MAPLE PL
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-2225
Mailing Address - Country:US
Mailing Address - Phone:315-717-9599
Mailing Address - Fax:
Practice Address - Street 1:71 MAPLE PL
Practice Address - Street 2:
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357-2225
Practice Address - Country:US
Practice Address - Phone:315-717-9599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2855131164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse