Healthcare Provider Details

I. General information

NPI: 1174187546
Provider Name (Legal Business Name): CONSTANCE L COLLMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 S WHITE MOUNTAIN RD BLDG A
SHOW LOW AZ
85901-7827
US

IV. Provider business mailing address

4951 S WHITE MOUNTAIN RD BLDG A
SHOW LOW AZ
85901-7827
US

V. Phone/Fax

Practice location:
  • Phone: 928-537-6700
  • Fax: 928-532-9945
Mailing address:
  • Phone: 928-537-6700
  • Fax: 928-532-9945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number224146
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: