Provider Demographics
NPI:1659632321
Name:COLLINS, JACQUELINE SUE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SUE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 FORBES AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3120
Mailing Address - Country:US
Mailing Address - Phone:412-247-7802
Mailing Address - Fax:412-247-7959
Practice Address - Street 1:3333 FORBES AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3120
Practice Address - Country:US
Practice Address - Phone:412-247-7802
Practice Address - Fax:412-247-7959
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN222617L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse