Healthcare Provider Details

I. General information

NPI: 1730119207
Provider Name (Legal Business Name): JILL K COLIN CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 MEGAN FAYE ST
NORTH LAS VEGAS NV
89031-3564
US

IV. Provider business mailing address

5535 MEGAN FAYE ST
NORTH LAS VEGAS NV
89031-3564
US

V. Phone/Fax

Practice location:
  • Phone: 702-243-0944
  • Fax: 702-645-8352
Mailing address:
  • Phone: 702-243-0944
  • Fax: 702-645-8352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: