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General NPI Number Information
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NPI Number | 1396866133
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Entity Type | Individual
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Provider Name | COURTNEY ANNE COLVILLE MD
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 420 VICTORY PARK DR
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City | LINCOLN
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State | NE
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Zip | 68510-2484
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Country | US
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Telephone | 402-489-3802
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Fax |
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Provider Business Mailing Address
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Address Line | ONE VETERANS DRIVE VA MEDICAL CENTER
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City | MINNEAPOLIS
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State | MN
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Zip | 55417
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Country | US
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Telephone | 612-467-3974
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Fax | 612-725-2292
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 50948
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License Number State | MN
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