MEDICARE: COLLETTE ECHOLS

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	133NN1002X	Nutrition Education Nutritionist
2	163W00000X	Registered Nurse	RN167899	AZ
3	163WA2000X	Administrator Registered Nurse	167899	AZ
4	163WH0200X	Home Health Registered Nurse	167899	AZ
5	364SC1501X	Community Health/Public Health Clinical Nurse Specialist	167899	AZ
6	163WC1600X	Continuing Education/Staff Development Registered Nurse	167899	AZ

General Provider Information

NPI Number	:	1407405616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLETTE ECHOLS

Provider Business Mailing Address
First Line	:	PO BOX 23433
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85063-3433
Country	:	US
Telephone Number	:	602-767-3634
Fax Number	:

Provider Business Practice Location Address
First Line	:	7935 W ATLANTIS WAY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-1638
Country	:	US
Telephone Number	:	602-767-3634
Fax Number	:

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

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	10/12/2023

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