MEDICARE: MS. NANETTE S COLLING LMSW

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1649371774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANETTE S COLLING LMSW

Provider Business Mailing Address
First Line	:	4646 JOHN R ST # 11MH-DOM
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-1916
Country	:	US
Telephone Number	:	313-576-1556
Fax Number	:	313-576-1560

Provider Business Practice Location Address
First Line	:	4777 E OUTER DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-3241
Country	:	US
Telephone Number	:	313-576-1556
Fax Number	:	313-576-1570

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/08/2007

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