Healthcare Provider Details

I. General information

NPI: 1952483794
Provider Name (Legal Business Name): CATHERINE ANN COLLINS-FULEA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD HENRY FORD HOSPITAL, OB GYN DEPARTMENT
DETROIT MI
48202-2608
US

IV. Provider business mailing address

2955 SKYLINE DRIVE
WINDSOR ONTARIO
N9E 3A6
CA

V. Phone/Fax

Practice location:
  • Phone: 313-790-0786
  • Fax: 313-916-5008
Mailing address:
  • Phone: 313-790-0786
  • Fax: 313-916-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704130311
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: