Provider Demographics
NPI:1477153138
Name:COLLINS, WALTER EUGENE
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:EUGENE
Last Name:COLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 ANNA LAURA AVE
Mailing Address - Street 2:
Mailing Address - City:DELBARTON
Mailing Address - State:WV
Mailing Address - Zip Code:25670-9792
Mailing Address - Country:US
Mailing Address - Phone:304-426-8131
Mailing Address - Fax:
Practice Address - Street 1:72 ANNA LAURA AVE
Practice Address - Street 2:
Practice Address - City:DELBARTON
Practice Address - State:WV
Practice Address - Zip Code:25670-9792
Practice Address - Country:US
Practice Address - Phone:304-426-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant