Provider Demographics
NPI:1417325879
Name:COLLINS, MEGAN R (PA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:R
Last Name:COLLINS
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1711 S STEPHENSON AVE
Mailing Address - Street 2:STE 115
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3639
Mailing Address - Country:US
Mailing Address - Phone:906-776-5970
Mailing Address - Fax:906-228-0215
Practice Address - Street 1:1721 S STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3637
Practice Address - Country:US
Practice Address - Phone:906-774-1313
Practice Address - Fax:989-340-1214
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2016-10-20
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Provider Licenses
StateLicense IDTaxonomies
MI5601007469363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP17840027Medicare PIN