Healthcare Provider Details

I. General information

NPI: 1023303872
Provider Name (Legal Business Name): MARIE DENISE COLVERT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: M. DENISE COLVERT FNP

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 SCHENECTADY AVE EMERGENCY DEPARTMENT
BROOKLYN NY
11203-1809
US

IV. Provider business mailing address

126 MACDOUGAL ST
BROOKLYN NY
11233-2625
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-5000
  • Fax:
Mailing address:
  • Phone: 347-414-0696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number336686
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: