Provider Demographics
NPI:1275560138
Name:COLLINS, CHRISTIANNE LENETT (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTIANNE
Middle Name:LENETT
Last Name:COLLINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1414 WEST FAIR AVE
Mailing Address - Street 2:STE 342
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:906-225-3870
Mailing Address - Fax:906-225-3975
Practice Address - Street 1:1414 WEST FAIR AVE
Practice Address - Street 2:STE 342
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-225-3870
Practice Address - Fax:906-225-3975
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704224929363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008701110OtherBLUE CROSS BLUE SHIELD
MI5008701110OtherBLUE CROSS BLUE SHIELD
P57606Medicare UPIN