Provider Demographics
NPI:1689157737
Name:KOLLINS, JULIE (APN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:KOLLINS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4602
Mailing Address - Country:US
Mailing Address - Phone:847-754-3170
Mailing Address - Fax:847-754-3171
Practice Address - Street 1:800 W OAKTON ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4602
Practice Address - Country:US
Practice Address - Phone:847-754-3170
Practice Address - Fax:847-754-3171
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017743363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209017743OtherSTATE OF IL APN LICENSE