MEDICARE: ANN MARIE COLLINS WHNP-C

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	363LW0102X	Women's Health Nurse Practitioner	RN079115	AZ

General Provider Information

NPI Number	:	1639266919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MARIE COLLINS WHNP-C

Provider Business Mailing Address
First Line	:	6744 W ORAIBI DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-5503
Country	:	US
Telephone Number	:	632-825-7647
Fax Number	:

Provider Business Practice Location Address
First Line	:	17612 N 59TH AVE
Second Line	:	SUITE 100
City	:	GLENDALE
State	:	AZ
Zip	:	85308-3795
Country	:	US
Telephone Number	:	602-993-8636
Fax Number	:	602-993-2528

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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