Provider Demographics
NPI:1174565204
Name:FLEMING-DAMON, COLLEEN B (MSN)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:B
Last Name:FLEMING-DAMON
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5506
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90231-5506
Mailing Address - Country:US
Mailing Address - Phone:845-744-3498
Mailing Address - Fax:
Practice Address - Street 1:45 READE PL
Practice Address - Street 2:VASSAR BROTHERS MEDICAL CENTER
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3947
Practice Address - Country:US
Practice Address - Phone:845-454-8500
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303827-1163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF303827-1OtherNURSING LICENSE NUMBER