Provider Demographics
NPI:1497279673
Name:COLLIER, MARY ANN (AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:COLLIER
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3589 EL REGO DR
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-1653
Mailing Address - Country:US
Mailing Address - Phone:513-505-6612
Mailing Address - Fax:
Practice Address - Street 1:3589 EL REGO DR
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-1653
Practice Address - Country:US
Practice Address - Phone:513-505-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00020471363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health