Provider Demographics
NPI:1679595896
Name:NOWELL, COLLEEN ELIZABETH (FNP)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ELIZABETH
Last Name:NOWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:COLLEEN
Other - Middle Name:ELIZABETH
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 IRVING AVENUE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-425-2433
Mailing Address - Fax:315-425-3457
Practice Address - Street 1:800 IRVING AVENUE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-425-2433
Practice Address - Fax:315-425-3457
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332666363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026558506OtherUNIVERA
NY050404000010OtherFIDELIS
NY000560642002OtherBLUE CROSS OF WNY
NY9512184OtherINDEPENDENT HEALTH
NYP00107605OtherRAILROAD MEDICARE
NYP63141Medicare UPIN
NYRA1921Medicare ID - Type UnspecifiedMEDICARE PART B
NY00026558506OtherUNIVERA
NY000560642002OtherBLUE CROSS OF WNY