Healthcare Provider Details

I. General information

NPI: 1104499854
Provider Name (Legal Business Name): LAUREL E COLVIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 BOYNTON AVE
PLATTSBURGH NY
12901-1237
US

IV. Provider business mailing address

128 BOYNTON AVE
PLATTSBURGH NY
12901-1237
US

V. Phone/Fax

Practice location:
  • Phone: 518-324-3399
  • Fax:
Mailing address:
  • Phone: 518-324-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number735763
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number351287
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: