Provider Demographics
NPI:1689205130
Name:COLLINS, SARAH E (LPN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 PINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NY
Mailing Address - Zip Code:14772-9641
Mailing Address - Country:US
Mailing Address - Phone:716-720-3055
Mailing Address - Fax:
Practice Address - Street 1:356 MAIN STREET ER
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NY
Practice Address - Zip Code:14772-9696
Practice Address - Country:US
Practice Address - Phone:716-358-3636
Practice Address - Fax:716-358-2342
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297357164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse