Healthcare Provider Details

I. General information

NPI: 1245013242
Provider Name (Legal Business Name): ANN VICTORIA COLTON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 KISH RD
REEDSVILLE PA
17084-8943
US

IV. Provider business mailing address

1800 E PARK AVE
STATE COLLEGE PA
16803-6701
US

V. Phone/Fax

Practice location:
  • Phone: 717-667-7720
  • Fax: 717-667-7245
Mailing address:
  • Phone: 814-231-7100
  • Fax: 814-238-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP027994
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: