MEDICARE: ANNETTE 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	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1437767126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE COLLINS

Provider Business Mailing Address
First Line	:	1366 W CHEYENNE AVE STE 104
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7838
Country	:	US
Telephone Number	:	702-489-8094
Fax Number	:

Provider Business Practice Location Address
First Line	:	1366 W CHEYENNE AVE STE 104
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7838
Country	:	US
Telephone Number	:	702-489-8094
Fax Number	:

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

Provider Enumeration Date	:	07/19/2020
Last Update Date	:	07/19/2020

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Directions to “ ANNETTE COLLINS ” Practice Location

Language	Start Address	Practice Location

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