Provider Demographics
NPI:1134133283
Name:COOLEY, CHRISTINE M (FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:COOLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 WEATHERWAX RD
Mailing Address - Street 2:
Mailing Address - City:POESTENKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12140-2711
Mailing Address - Country:US
Mailing Address - Phone:518-283-1602
Mailing Address - Fax:
Practice Address - Street 1:500 FEDERAL STREET
Practice Address - Street 2:SUITE 650
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2867
Practice Address - Country:US
Practice Address - Phone:518-441-8720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331785-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB B3924Medicare ID - Type Unspecified