Provider Demographics
NPI:1619480308
Name:COLBY, VALORIE ELAINE
Entity type:Individual
Prefix:
First Name:VALORIE
Middle Name:ELAINE
Last Name:COLBY
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:EASTERN FAMILY RESOURCE CENTER
Mailing Address - Street 2:9150 FRANKLIN SQUARE DRIVE
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237
Mailing Address - Country:US
Mailing Address - Phone:410-887-1020
Mailing Address - Fax:
Practice Address - Street 1:EASTERN FAMILY RESOURCE CENTER
Practice Address - Street 2:9150 FRANKLIN SQUARE DRIVE
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237
Practice Address - Country:US
Practice Address - Phone:410-887-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR153983163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health