Healthcare Provider Details

I. General information

NPI: 1194559310
Provider Name (Legal Business Name): JULIA COLLINS CARE COORDINATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MAIN ST. #211
KETCHIKAN AK
99901
US

IV. Provider business mailing address

328 BRYANT ST
KETCHIKAN AK
99901-5538
US

V. Phone/Fax

Practice location:
  • Phone: 940-514-4108
  • Fax: 888-925-8338
Mailing address:
  • Phone: 940-514-4108
  • Fax: 888-925-8338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: