MEDICARE: DR. ANGELA JEANETTE COLLINS DO

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	207Q00000X	Family Medicine Physician	4347	OK
2	207Q00000X	Family Medicine Physician	OP61072319	WA
3	207Q00000X	Family Medicine Physician	2007008847	MO

General Provider Information

NPI Number	:	1841389517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA JEANETTE COLLINS DO

Provider Business Mailing Address
First Line	:	PO BOX 4825
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-4825
Country	:	US
Telephone Number	:	360-882-2778
Fax Number	:

Provider Business Practice Location Address
First Line	:	291 C ST UNIT 110
Second Line	:
City	:	WASHOUGAL
State	:	WA
Zip	:	98671-2168
Country	:	US
Telephone Number	:	360-882-2778
Fax Number	:	360-604-1644

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	10/14/2020

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