Healthcare Provider Details

I. General information

NPI: 1770023731
Provider Name (Legal Business Name): COLLEEN CONWAY-EDWARDS AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E ALBANY ST
HERKIMER NY
13350-2016
US

IV. Provider business mailing address

1 ATWELL RD
COOPERSTOWN NY
13326-1301
US

V. Phone/Fax

Practice location:
  • Phone: 315-867-2700
  • Fax: 215-867-2717
Mailing address:
  • Phone: 607-547-3480
  • Fax: 607-547-5196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number310515
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: