Provider Demographics
NPI:1407405616
Name:ECHOLS, COLLETTE
Entity Type:Individual
Prefix:
First Name:COLLETTE
Middle Name:
Last Name:ECHOLS
Suffix:
Gender:F
Credentials:
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 23433
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85063-3433
Mailing Address - Country:US
Mailing Address - Phone:602-767-3634
Mailing Address - Fax:
Practice Address - Street 1:7935 W ATLANTIS WAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-1638
Practice Address - Country:US
Practice Address - Phone:602-767-3634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
AZRN167899163W00000X
AZ167899163WA2000X, 163WH0200X, 364SC1501X, 163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health