Provider Demographics
NPI:1114954799
Name:HURLEY, COLLEEN ANN (CPNP)
Entity Type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:ANN
Last Name:HURLEY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1009
Mailing Address - Country:US
Mailing Address - Phone:716-323-0220
Mailing Address - Fax:716-323-0293
Practice Address - Street 1:1001 MAIN ST FL 4
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1009
Practice Address - Country:US
Practice Address - Phone:716-323-0220
Practice Address - Fax:716-323-0293
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380834363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
000560217002OtherBC/BS
051006000085OtherFIDELIS
PA0014387840001Medicaid
NY01907280Medicaid
0002670301OtherUNIVERA
4513051OtherIHA
0002670301OtherUNIVERA
S92142Medicare UPIN