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General NPI Number Information
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NPI Number | 1407831944
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Entity Type | Individual
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Provider Name | COLLEEN A. MCCORMICK CRNA
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Gender | Female
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Dates
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Enumeration Date | 12/07/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 216 LOGAN LN CRNA - MEDICAL DOCTOR ASSOCIATES
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City | MAHOPAC
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State | NY
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Zip | 10541-3650
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Country | US
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Telephone | 888-400-8878
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Fax | 845-621-1911
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Provider Business Mailing Address
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Address Line | 21 WILDWOOD EST
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City | PLATTSBURGH
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State | NY
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Zip | 12901-5002
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Country | US
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Telephone | 518-561-2214
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 101-0017589
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 5039101
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License Number State | NY
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