Healthcare Provider Details

I. General information

NPI: 1215443338
Provider Name (Legal Business Name): RACHAEL ANASTASIO COLLINS BSN, RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 CAMERON COMMONS WAY
MATTHEWS NC
28104-1171
US

IV. Provider business mailing address

2818 CAMERON COMMONS WAY
MATTHEWS NC
28104-1171
US

V. Phone/Fax

Practice location:
  • Phone: 704-291-8008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-56471
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-56471
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: