Healthcare Provider Details

I. General information

NPI: 1063418697
Provider Name (Legal Business Name): DEA NASON COLLINS MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 W STEWART AVE
MEDFORD OR
97501-3663
US

IV. Provider business mailing address

2900 DOCTORS PARK DR SUITE 250
MEDFORD OR
97504-8198
US

V. Phone/Fax

Practice location:
  • Phone: 541-282-8808
  • Fax: 541-618-6452
Mailing address:
  • Phone: 541-282-8808
  • Fax: 541-618-6452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number097006629N1
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: