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NPI Code Detail

MEDICARE: AUDRA COLLINS

MEDICARE:   AUDRA  COLLINS
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
1363LF0000XFamily Nurse PractitionerF0215393MI
2363LF0000XFamily Nurse Practitioner4704281339MI

General Provider Information

NPI Number : 1659766012
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDRA COLLINS
Provider Business Mailing Address
First Line : 1135 W UNIVERSITY DR
Second Line : SUITE 220
City : ROCHESTER HILLS
State : MI
Zip : 48307-1871
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 W WEST MAPLE RD
Second Line :
City : WALLED LAKE
State : MI
Zip : 48390-3402
Country : US
Telephone Number : 248-624-4555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2015
Last Update Date : 01/24/2019

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Directions to “ AUDRA COLLINS ” Practice Location

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