Provider Demographics
NPI:1750707691
Name:COLON-PEREZ, MIRIAM (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:COLON-PEREZ
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1840
Mailing Address - Country:US
Mailing Address - Phone:718-605-6443
Mailing Address - Fax:
Practice Address - Street 1:189 EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-1840
Practice Address - Country:US
Practice Address - Phone:718-605-6443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY429101163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse