Provider Demographics
NPI:1174799480
Name:KRATZER, COLLEEN JOAN (LPN)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:JOAN
Last Name:KRATZER
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 1:31 PARDEE ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1923
Mailing Address - Country:US
Mailing Address - Phone:607-661-5727
Mailing Address - Fax:
Practice Address - Street 1:31 PARDEE ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1923
Practice Address - Country:US
Practice Address - Phone:607-661-5727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198728-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02043570Medicaid