Healthcare Provider Details

I. General information

NPI: 1699546093
Provider Name (Legal Business Name): KAYLA COLLINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NORTH WABASH AVENUE SUITE 100, MAILBOX#3902
CHICAGO IL
60602
US

IV. Provider business mailing address

111 N WABASH AVE STE 100
CHICAGO IL
60602-1903
US

V. Phone/Fax

Practice location:
  • Phone: 773-516-0151
  • Fax:
Mailing address:
  • Phone: 773-516-0151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: