Healthcare Provider Details

I. General information

NPI: 1548402316
Provider Name (Legal Business Name): EVERDEAN T COLLINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 JEFFERSON AVE
FORT EUSTIS VA
23604-1602
US

IV. Provider business mailing address

576 JEFFERSON AVE
FORT EUSTIS VA
23604-5548
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number0001086639
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: