| Doctor Name: | MRS. COLLEEN MARIE PROROK |
| NPI Number: | 1548405483 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, MSN, IBCLC |
| License Number: | R052436 |
| Business Practice Address: | 2000 Carter Mill Way Brookeville, MD - 208332243 |
| Business Phone Number: | 3017747279 |
| Business Fax Number: | 3017747279 |
| Mailing Address: | 2000 Carter Mill Way, BROOKEVILLE |
| State: | MD |
| Postal Code: | 208332243 |
| Phone Number: | 3017747279 |
| Fax Number: | 3017747279 |
| NPI Enumeration Date: | 12/05/2008 |
| NPI Last Update Date: | 12/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WL0100X |
| License Number: | R052436 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Lactation Consultant |
| Taxonomy Definition: | |