Healthcare Provider Details

I. General information

NPI: 1639542483
Provider Name (Legal Business Name): JANELLE ELIZABETH COLQUHOUN ANP-B.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 12/18/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 BAILEY AVE
BUFFALO NY
14215-1129
US

IV. Provider business mailing address

34 BENWOOD AVE
BUFFALO NY
14214-1761
US

V. Phone/Fax

Practice location:
  • Phone: 716-862-8858
  • Fax:
Mailing address:
  • Phone: 716-986-9199
  • Fax: 716-835-9357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF30726-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: