1053727941 NPI number — COLLEEN PALERMO DNP, FNP

Table of content: COLLEEN PALERMO DNP, FNP (NPI 1053727941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053727941 NPI number — COLLEEN PALERMO DNP, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALERMO
Provider First Name:
COLLEEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALSH
Provider Other First Name:
COLLEEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DNP, FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053727941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 KINGS HWY S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14617-5504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-368-3506
Provider Business Mailing Address Fax Number:
585-368-3163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
89 GENESEE ST
Provider Second Line Business Practice Location Address:
BK BUILDING, 3RD FLOOR
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14611-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-368-3506
Provider Business Practice Location Address Fax Number:
585-368-3163
Provider Enumeration Date:
07/11/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  338728 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03913320 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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