Healthcare Provider Details

I. General information

NPI: 1700109733
Provider Name (Legal Business Name): DONNA K COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W POPLAR ST
ROGERS AR
72756-4558
US

IV. Provider business mailing address

317 W POPLAR ST
ROGERS AR
72756-4558
US

V. Phone/Fax

Practice location:
  • Phone: 479-631-1010
  • Fax: 479-631-1196
Mailing address:
  • Phone: 479-631-1010
  • Fax: 479-631-1196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number215
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: