Healthcare Provider Details

I. General information

NPI: 1497259584
Provider Name (Legal Business Name): KARA JEAN COLBURN BSN, RN, RNFA, CST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 ORCHARD PARK RD
WEST SENECA NY
14224-2646
US

IV. Provider business mailing address

550 ORCHARD PARK RD
WEST SENECA NY
14224-2646
US

V. Phone/Fax

Practice location:
  • Phone: 716-677-5005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number711868-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number133788
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number711868-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: