Healthcare Provider Details

I. General information

NPI: 1679291959
Provider Name (Legal Business Name): ANNA LEE COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 SUPERIOR ST
WEBSTER CITY IA
50595-3146
US

IV. Provider business mailing address

1316 S MAIN ST
CLARION IA
50525-2019
US

V. Phone/Fax

Practice location:
  • Phone: 515-832-3332
  • Fax:
Mailing address:
  • Phone: 515-532-9287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA170124
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: