Healthcare Provider Details

I. General information

NPI: 1316251002
Provider Name (Legal Business Name): NITA JANECE COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 TOWNSGATE PLZ
CLOVIS NM
88101-3714
US

IV. Provider business mailing address

1574 ANVIL PL APT A
CLOVIS NM
88101-2545
US

V. Phone/Fax

Practice location:
  • Phone: 575-742-2620
  • Fax: 575-742-3182
Mailing address:
  • Phone: 405-229-6960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: