Healthcare Provider Details

I. General information

NPI: 1659260081
Provider Name (Legal Business Name): JIL D COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2560
US

IV. Provider business mailing address

70535 SUNSET BLVD
UNION MI
49130-9735
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number28270331A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: