Healthcare Provider Details

I. General information

NPI: 1285552182
Provider Name (Legal Business Name): LATRIEVA COLLINS
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: LATRIEVA BOSTON

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 W KALAMAZOO AVE
KALAMAZOO MI
49007-3334
US

IV. Provider business mailing address

418 W KALAMAZOO AVE
KALAMAZOO MI
49007-3334
US

V. Phone/Fax

Practice location:
  • Phone: 269-343-5896
  • Fax: 269-978-0287
Mailing address:
  • Phone: 269-343-5896
  • Fax: 269-978-0287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: