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General NPI Number Information
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NPI Number | 1427474527
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Entity Type | Individual
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Provider Name | MR. STEPHEN COLLINS
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Gender | Male
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Dates
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Enumeration Date | 03/13/2014
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Last Update Date | 04/23/2023
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Provider Practice Location Address
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Address Line | 1684 FALLEN TIMBER ST NE
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City | CANTON
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State | OH
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Zip | 44721-3858
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Country | US
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Telephone | 330-265-7099
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Fax |
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Provider Business Mailing Address
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Address Line | 1684 FALLEN TIMBER ST NE
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City | CANTON
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State | OH
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Zip | 44721-3858
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Country | US
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Telephone | 330-265-7099
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 15412
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License Number State | OH
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