Individual
CONNIE COLVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
133 AVIATION RD, QUEENSBURY, NY 12804-8206
(518) 798-0170
(518) 761-9538
Mailing address
133 AVIATION RD, QUEENSBURY, NY 12804-8206
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
191210
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00752456
—
NY
Enumeration date
01/08/2013
Last updated
01/08/2013
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