Provider Demographics
NPI:1003884883
Name:COLLINS, EMMA MAUREEN (PA)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:MAUREEN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2105 BRAXTON LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2801
Mailing Address - Country:US
Mailing Address - Phone:336-333-6306
Mailing Address - Fax:336-333-6309
Practice Address - Street 1:2105 BRAXTON LN
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2801
Practice Address - Country:US
Practice Address - Phone:336-333-6306
Practice Address - Fax:336-333-6309
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0001-03846363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP68089Medicare UPIN
NC2759304Medicare ID - Type Unspecified