Provider Demographics
NPI:1649487455
Name:COLLINS, JODIE ELIZABETH (RN)
Entity type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:ELIZABETH
Last Name:COLLINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 25TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-4656
Mailing Address - Country:US
Mailing Address - Phone:309-786-9348
Mailing Address - Fax:
Practice Address - Street 1:1209 21ST AVE
Practice Address - Street 2:APT. 114
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-7900
Practice Address - Country:US
Practice Address - Phone:309-794-4138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse