Provider Demographics
NPI:1861813313
Name:COLGAN, AMY WILCOX (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:WILCOX
Last Name:COLGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:DIANE
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:364 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:PENNELLVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13132
Mailing Address - Country:US
Mailing Address - Phone:315-945-9006
Mailing Address - Fax:315-934-4143
Practice Address - Street 1:364 CENTER RD
Practice Address - Street 2:
Practice Address - City:PENNELLVILLE
Practice Address - State:NY
Practice Address - Zip Code:13132
Practice Address - Country:US
Practice Address - Phone:315-945-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-01
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY644816163W00000X, 163WC0400X, 163WP0809X
NY644816-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult