1770905978 NPI number — DEBORAH ANN COLLINS MS RD LD CDE

Table of content: DEBORAH ANN COLLINS MS RD LD CDE (NPI 1770905978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770905978 NPI number — DEBORAH ANN COLLINS MS RD LD CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
DEBORAH
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS RD LD CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770905978
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 14TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEATLAND
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82201-3201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-322-3636
Provider Business Mailing Address Fax Number:
307-322-5720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHEATLAND
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82201-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-322-3636
Provider Business Practice Location Address Fax Number:
307-322-5720
Provider Enumeration Date:
01/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  15 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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