Provider Demographics
NPI:1467508267
Name:COLLISS, WENDY (RN)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:COLLISS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CHURCHILL LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4355
Mailing Address - Country:US
Mailing Address - Phone:302-239-7268
Mailing Address - Fax:302-239-4301
Practice Address - Street 1:125 CHURCHILL LN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4355
Practice Address - Country:US
Practice Address - Phone:302-239-7268
Practice Address - Fax:302-239-4301
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0018404163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse