1679595896 NPI number — MS. COLLEEN ELIZABETH NOWELL FNP

Table of content: MS. COLLEEN ELIZABETH NOWELL FNP (NPI 1679595896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679595896 NPI number — MS. COLLEEN ELIZABETH NOWELL FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOWELL
Provider First Name:
COLLEEN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCOY
Provider Other First Name:
COLLEEN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679595896
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 IRVING AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-425-2433
Provider Business Mailing Address Fax Number:
315-425-3457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 IRVING AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-425-2433
Provider Business Practice Location Address Fax Number:
315-425-3457
Provider Enumeration Date:
07/24/2006

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: 363L00000X , with the licence number:  332666 , 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: 00026558506 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 050404000010 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000560642002 . This is a "BLUE CROSS OF WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9512184 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00107605 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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