MEDICARE: MRS. LETHIA ANNETTE COLLINS FNP, RNFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	7100612A	IN
2	163WR0006X	Registered Nurse First Assistant	71000612A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053392712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LETHIA ANNETTE COLLINS FNP, RNFA

Provider Business Mailing Address
First Line	:	10017 COUNTY LINE RD
Second Line	:
City	:	SELLERSBURG
State	:	IN
Zip	:	47172-9207
Country	:	US
Telephone Number	:	812-246-8710
Fax Number	:	812-949-7179

Provider Business Practice Location Address
First Line	:	10017 COUNTY LINE RD
Second Line	:
City	:	SELLERSBURG
State	:	IN
Zip	:	47172-9207
Country	:	US
Telephone Number	:	812-246-8710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	07/25/2008

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