Healthcare Provider Details

I. General information

NPI: 1114954799
Provider Name (Legal Business Name): COLLEEN ANN HURLEY CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST FL 4
BUFFALO NY
14203-1009
US

IV. Provider business mailing address

1001 MAIN ST FL 5
BUFFALO NY
14203-1009
US

V. Phone/Fax

Practice location:
  • Phone: 716-323-0220
  • Fax: 716-323-0293
Mailing address:
  • Phone: 716-323-0220
  • Fax: 716-323-0293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF380834
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: