Provider Demographics
NPI:1336653401
Name:MCGLYNN-LANDRY, COLEEN (NP)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:
Last Name:MCGLYNN-LANDRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:COLEEN
Other - Middle Name:MCGLYNN
Other - Last Name:LANDRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:331 E 71ST ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4735
Mailing Address - Country:US
Mailing Address - Phone:917-539-8925
Mailing Address - Fax:
Practice Address - Street 1:214 W HOUSTON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-4846
Practice Address - Country:US
Practice Address - Phone:917-539-8925
Practice Address - Fax:917-539-8925
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF308276-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health