Provider Demographics
NPI:1942588900
Name:COLLINS, KATIE LYNN (NP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:744 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3581
Practice Address - Country:US
Practice Address - Phone:920-436-8691
Practice Address - Fax:920-436-8699
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4548-33363LF0000X
WI151250-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
F0711070OtherAMERICAN ACADEMY NURSE PRACTITIONERS
WI1942588900Medicaid
WI1942588900Medicaid
WI075100137Medicare Oscar/Certification
WIWI1119016Medicare Oscar/Certification
WI100200076Medicare Oscar/Certification