Provider Demographics
NPI:1013544196
Name:COLLINS, SANDRA DELORES (CNM)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DELORES
Last Name:COLLINS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2106
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-2106
Mailing Address - Country:US
Mailing Address - Phone:601-486-4210
Mailing Address - Fax:601-486-4219
Practice Address - Street 1:RUSH CENTRAL CLINIC
Practice Address - Street 2:1221 24TH AVENUE
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3926
Practice Address - Country:US
Practice Address - Phone:601-486-4210
Practice Address - Fax:601-486-4219
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife