Provider Demographics
NPI:1891710901
Name:COLLINS, LAURA (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:217 RICE LAKE SQ
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-2136
Practice Address - Country:US
Practice Address - Phone:630-221-1883
Practice Address - Fax:630-221-1885
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005550363L00000X
NDR49968363LA2200X
VT101.0134697363LA2200X
IAH162838363LA2200X
MT173379363LA2200X
NM62265363LA2200X
NE113423363LA2200X
IL277.000163363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicaid
ILP00250847OtherRR MEDICARE
IL$$$$$$$$$-001Medicaid
ILK20009Medicare ID - Type Unspecified