Provider Demographics
NPI:1497983993
Name:COLLINS, ANDREA LYNNETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LYNNETTE
Last Name:COLLINS
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 1:1928 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43217-1019
Mailing Address - Country:US
Mailing Address - Phone:740-408-6130
Mailing Address - Fax:
Practice Address - Street 1:1928 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43217-1019
Practice Address - Country:US
Practice Address - Phone:740-408-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2012-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-123225 IV164W00000X
OHRN.385111163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse