Provider Demographics
NPI:1508315524
Name:COLWELL, KRISTINA (CNM)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:COLWELL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:COLWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM
Mailing Address - Street 1:133 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1244
Mailing Address - Country:US
Mailing Address - Phone:518-483-3000
Mailing Address - Fax:
Practice Address - Street 1:590 COUNTRY CLUB PKWY STE B
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6025
Practice Address - Country:US
Practice Address - Phone:541-686-2922
Practice Address - Fax:541-683-1709
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201606041NP-PP367A00000X
NY001763367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife