Provider Demographics
NPI:1376514117
Name:COLLINS, MARYANN (NP)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 REDWOOD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PENNINGTON GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24277-2599
Mailing Address - Country:US
Mailing Address - Phone:276-546-5310
Mailing Address - Fax:276-546-5469
Practice Address - Street 1:185 REDWOOD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-2599
Practice Address - Country:US
Practice Address - Phone:276-546-5310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024073915363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily