Healthcare Provider Details

I. General information

NPI: 1407405616
Provider Name (Legal Business Name): COLLETTE ECHOLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7935 W ATLANTIS WAY
PHOENIX AZ
85043-1638
US

IV. Provider business mailing address

PO BOX 23433
PHOENIX AZ
85063-3433
US

V. Phone/Fax

Practice location:
  • Phone: 602-767-3634
  • Fax:
Mailing address:
  • Phone: 602-767-3634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN167899
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number167899
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number167899
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number167899
License Number StateAZ
# 6
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number167899
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: