Healthcare Provider Details

I. General information

NPI: 1972883924
Provider Name (Legal Business Name): COLLEEN O'NEILL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 READE PL
POUGHKEEPSIE NY
12601-3947
US

IV. Provider business mailing address

68 S SERVICE RD SUITE 350
MELVILLE NY
11747-2354
US

V. Phone/Fax

Practice location:
  • Phone: 845-431-5629
  • Fax: 845-437-3145
Mailing address:
  • Phone: 516-945-3107
  • Fax: 516-945-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number562206
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: