Provider Demographics
NPI:1558463455
Name:METZ, COLLEEN KOPER (FNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:KOPER
Last Name:METZ
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 1:167 SULLYS TRL STE 100
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4568
Mailing Address - Country:US
Mailing Address - Phone:585-758-0800
Mailing Address - Fax:585-381-1577
Practice Address - Street 1:167 SULLYS TRL STE 100
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-4568
Practice Address - Country:US
Practice Address - Phone:585-758-0800
Practice Address - Fax:585-381-1577
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-05-15
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-06-20
Provider Licenses
StateLicense IDTaxonomies
NYF332613363L00000X, 363LF0000X
NY332613363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP12942Medicare UPIN
NYRA2193Medicare PIN