Provider Demographics
NPI:1578762738
Name:COLLINS, HERSCHEL DOUGLAS JR (RN)
Entity Type:Individual
Prefix:MR
First Name:HERSCHEL
Middle Name:DOUGLAS
Last Name:COLLINS
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 SAW MILL HL
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05767-9647
Mailing Address - Country:US
Mailing Address - Phone:802-767-3635
Mailing Address - Fax:
Practice Address - Street 1:555 SAW MILL HL
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05767-9647
Practice Address - Country:US
Practice Address - Phone:802-767-3635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026-0029786163W00000X
NH057450-21163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse