Healthcare Provider Details

I. General information

NPI: 1184279580
Provider Name (Legal Business Name): ZACHARY DANIEL COLLINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2019
Last Update Date: 08/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 VINE ST
CINCINNATI OH
45220-2213
US

IV. Provider business mailing address

1606 MUSKEGON DR
CINCINNATI OH
45255-3219
US

V. Phone/Fax

Practice location:
  • Phone: 513-600-5316
  • Fax:
Mailing address:
  • Phone: 513-600-5316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN.464636
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: