Provider Demographics
NPI:1073833323
Name:COLLINS, NICOLE WHITNEY (DO)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:WHITNEY
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 S MILLS ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1643
Mailing Address - Country:US
Mailing Address - Phone:253-777-2792
Mailing Address - Fax:
Practice Address - Street 1:509 S MILLS ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1643
Practice Address - Country:US
Practice Address - Phone:253-777-2792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014008819207L00000X
WI63809-21207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology