Provider Demographics
NPI:1407624695
Name:COLVIN, KRISTI JO
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:JO
Last Name:COLVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3256 HEMLOCK HL APT 4
Mailing Address - Street 2:
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502-8604
Mailing Address - Country:US
Mailing Address - Phone:315-576-9799
Mailing Address - Fax:
Practice Address - Street 1:3256 HEMLOCK HL APT 4
Practice Address - Street 2:
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-8604
Practice Address - Country:US
Practice Address - Phone:315-576-9799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty