Provider Demographics
NPI:1740979152
Name:HALE, COLEEN MARIE
Entity type:Individual
Prefix:
First Name:COLEEN
Middle Name:MARIE
Last Name:HALE
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 1:29205 GREEN DR
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-4707
Mailing Address - Country:US
Mailing Address - Phone:440-679-1282
Mailing Address - Fax:
Practice Address - Street 1:29205 GREEN DR
Practice Address - Street 2:
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095-4707
Practice Address - Country:US
Practice Address - Phone:440-679-1282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker