Healthcare Provider Details

I. General information

NPI: 1447583257
Provider Name (Legal Business Name): LYNNE M COLLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 VAIL RD
POUGHKEEPSIE NY
12603-6707
US

IV. Provider business mailing address

25 VAIL RD
POUGHKEEPSIE NY
12603-6707
US

V. Phone/Fax

Practice location:
  • Phone: 845-473-0150
  • Fax: 845-473-4204
Mailing address:
  • Phone: 845-473-0150
  • Fax: 845-473-4204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number576508
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: