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Individual

COLEEN CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ANP

Contact information

Practice address
656 ELMWOOD AVE, BUFFALO, NY 14222-1836
(716) 883-0515
(716) 883-8764
Mailing address
179 MONTBLEU DR, GETZVILLE, NY 14068-1330
(716) 697-2213

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
304179
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F404652-01
NY

Other

Enumeration date
04/29/2010
Last updated
09/03/2025
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