Provider Demographics
NPI:1740414036
Name:COLLINS, CHARLES KIRKLAND (RN)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:KIRKLAND
Last Name:COLLINS
Suffix:
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 1:706 COFFREN PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8555
Mailing Address - Country:US
Mailing Address - Phone:301-346-0351
Mailing Address - Fax:
Practice Address - Street 1:706 COFFREN PL
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8555
Practice Address - Country:US
Practice Address - Phone:301-346-0351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR123405163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse