Provider Demographics
NPI:1770073157
Name:COLLINS, CAROLE STALEY (PHD,MSN,RN)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:STALEY
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PHD,MSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 ANCHORAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-6314
Mailing Address - Country:US
Mailing Address - Phone:410-349-0229
Mailing Address - Fax:410-706-0140
Practice Address - Street 1:4915 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1224
Practice Address - Country:US
Practice Address - Phone:443-282-5577
Practice Address - Fax:410-706-0140
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR145852163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management