MEDICARE: MS. TEATA COLLIER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	604082	TX

General Provider Information

NPI Number	:	1275721177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TEATA COLLIER RN

Provider Business Mailing Address
First Line	:	243 SPYGLASS RD
Second Line	:
City	:	MC QUEENEY
State	:	TX
Zip	:	78123-3441
Country	:	US
Telephone Number	:	830-221-0115
Fax Number	:

Provider Business Practice Location Address
First Line	:	243 SPYGLASS RD
Second Line	:
City	:	MC QUEENEY
State	:	TX
Zip	:	78123-3441
Country	:	US
Telephone Number	:	830-221-0115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	02/21/2008

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