Provider Demographics
NPI:1326170200
Name:COLLARD, DORCAS EILEEN (PNP)
Entity Type:Individual
Prefix:MS
First Name:DORCAS
Middle Name:EILEEN
Last Name:COLLARD
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4381
Mailing Address - Country:US
Mailing Address - Phone:518-798-0528
Mailing Address - Fax:518-798-9576
Practice Address - Street 1:84 BROAD ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4381
Practice Address - Country:US
Practice Address - Phone:518-798-0528
Practice Address - Fax:518-798-9576
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380604-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03144314Medicaid