Provider Demographics
NPI:1073702460
Name:COLLINS, BRIAN MAURICE (RN)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MAURICE
Last Name:COLLINS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6481 HEATHER WAY
Mailing Address - Street 2:
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-2680
Mailing Address - Country:US
Mailing Address - Phone:804-452-1168
Mailing Address - Fax:804-452-1838
Practice Address - Street 1:6481 HEATHER WAY
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-2680
Practice Address - Country:US
Practice Address - Phone:804-452-1168
Practice Address - Fax:804-452-1838
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001177581163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse