Provider Demographics
NPI:1457382020
Name:COLLINS, JENNIFER ROBIN (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ROBIN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ROBIN
Other - Last Name:HATFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:534 PLEASANT VIEW WAY NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1789
Mailing Address - Country:US
Mailing Address - Phone:541-812-5656
Mailing Address - Fax:541-812-5660
Practice Address - Street 1:534 PLEASANT VIEW WAY NW
Practice Address - Street 2:SUITE 100
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1789
Practice Address - Country:US
Practice Address - Phone:541-812-5656
Practice Address - Fax:541-812-5660
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001718207Q00000X
ORDO167295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500677620Medicaid