Healthcare Provider Details

I. General information

NPI: 1720512007
Provider Name (Legal Business Name): PATRICE COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101-125 W 147TH ST APT 8C
NEW YORK NY
10039-4301
US

IV. Provider business mailing address

101-125 W 147TH ST APT 8C
NEW YORK NY
10039-4301
US

V. Phone/Fax

Practice location:
  • Phone: 212-694-4080
  • Fax:
Mailing address:
  • Phone: 212-694-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number694109
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: