Provider Demographics
NPI:1265711311
Name:COLLAR, KRISTIN M (APNP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:COLLAR
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:WI
Mailing Address - Zip Code:54165-8474
Mailing Address - Country:US
Mailing Address - Phone:920-833-2318
Mailing Address - Fax:
Practice Address - Street 1:405 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:WI
Practice Address - Zip Code:54165-8474
Practice Address - Country:US
Practice Address - Phone:920-833-2318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI154400163W00000X
WI4489-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1265711311Medicaid
WIK400105716Medicare Oscar/Certification
WI075100134Medicare Oscar/Certification
WI330350045Medicare Oscar/Certification
WI071700066Medicare Oscar/Certification
WIK400287353Medicare Oscar/Certification
WIK400216382Medicare Oscar/Certification