MEDICARE: VERONICA LYNN COLLINS

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	171M00000X	Case Manager/Care Coordinator

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	:	1104077627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA LYNN COLLINS

Provider Business Mailing Address
First Line	:	2200 GRANT ST
Second Line	:	SUITE 204
City	:	GARY
State	:	IN
Zip	:	46404-3439
Country	:	US
Telephone Number	:	219-887-5146
Fax Number	:	219-884-2756

Provider Business Practice Location Address
First Line	:	2200 GRANT ST
Second Line	:	SUITE 204
City	:	GARY
State	:	IN
Zip	:	46404-3439
Country	:	US
Telephone Number	:	219-887-5146
Fax Number	:	219-884-2756

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

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	10/17/2008

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