Healthcare Provider Details

I. General information

NPI: 1295251890
Provider Name (Legal Business Name): NITA COLLINS CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BERNITA VARNER CDCA

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 08/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 S 2ND ST
HAMILTON OH
45011-2936
US

IV. Provider business mailing address

820 S MARTIN LUTHER KING JR BLVD
HAMILTON OH
45011-3216
US

V. Phone/Fax

Practice location:
  • Phone: 513-868-4980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCDCA.150318
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: