Provider Demographics
NPI:1013215375
Name:COLLINS, HEATHER IRENE (NP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:IRENE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:IRENE
Other - Last Name:WOODARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4650 W SUNSET BLVD
Mailing Address - Street 2:MAIL STOP #66
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-4148
Mailing Address - Fax:323-361-3668
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:MAIL STOP #66
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-4148
Practice Address - Fax:323-361-3668
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19806363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics