Provider Demographics
NPI:1417600180
Name:COLLINS, CARLA DIONNE
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:DIONNE
Last Name:COLLINS
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 1:411 E CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662-1943
Mailing Address - Country:US
Mailing Address - Phone:319-222-1758
Mailing Address - Fax:
Practice Address - Street 1:201 PARK AVE
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:IA
Practice Address - Zip Code:50674-1649
Practice Address - Country:US
Practice Address - Phone:319-222-1758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA171400000X
IA87-4580704163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach