Provider Demographics
NPI:1912704776
Name:COLON, MARIAH YELISA (NURSES AID)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:YELISA
Last Name:COLON
Suffix:
Gender:
Credentials:NURSES AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 WILDA AVE
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2920
Mailing Address - Country:US
Mailing Address - Phone:330-261-1267
Mailing Address - Fax:
Practice Address - Street 1:94 WILDA AVE
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-2920
Practice Address - Country:US
Practice Address - Phone:330-261-1267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide