Healthcare Provider Details

I. General information

NPI: 1669755963
Provider Name (Legal Business Name): ANNIKA KATHERINE COLLINS A.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 10/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 W WISCONSIN AVE
MILWAUKEE WI
53208-3182
US

IV. Provider business mailing address

3727 W WISCONSIN AVE
MILWAUKEE WI
53208-3182
US

V. Phone/Fax

Practice location:
  • Phone: 414-291-2626
  • Fax:
Mailing address:
  • Phone: 414-291-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number165118-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4614-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: