Provider Demographics
NPI:1255511069
Name:COLLIER, THADINE KATHERINE (RN, CNOR, RNFA)
Entity type:Individual
Prefix:MRS
First Name:THADINE
Middle Name:KATHERINE
Last Name:COLLIER
Suffix:
Gender:F
Credentials:RN, CNOR, RNFA
Other - Prefix:MISS
Other - First Name:THADINE
Other - Middle Name:KATHERINE
Other - Last Name:WAKULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1261 W GENESEE STREET RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-9566
Mailing Address - Country:US
Mailing Address - Phone:315-253-4367
Mailing Address - Fax:
Practice Address - Street 1:1261 W GENESEE STREET RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-9566
Practice Address - Country:US
Practice Address - Phone:315-253-4367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279498-1163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant