MEDICARE: MICHELLE MARIE COLLARD R.N.

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	163W00000X	Registered Nurse	RN00114893	WA

General Provider Information

NPI Number	:	1841464211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MARIE COLLARD R.N.

Provider Business Mailing Address
First Line	:	7338 ALLENS PARK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-1277
Country	:	US
Telephone Number	:	719-213-5115
Fax Number	:

Provider Business Practice Location Address
First Line	:	7338 ALLENS PARK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-1277
Country	:	US
Telephone Number	:	719-213-5115
Fax Number	:

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

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	04/16/2008

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