Healthcare Provider Details

I. General information

NPI: 1891333522
Provider Name (Legal Business Name): ADAM COLLIER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST BLVD
ELKHART IN
46514-2483
US

IV. Provider business mailing address

851 W 2800 N
PLEASANT GROVE UT
84062-8027
US

V. Phone/Fax

Practice location:
  • Phone: 574-524-8130
  • Fax: 574-524-8138
Mailing address:
  • Phone: 801-641-2936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28254463A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: