Provider Demographics
NPI:1770905978
Name:COLLINS, DEBORAH ANN (MS RD LD CDE)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS RD LD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 14TH ST
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-3201
Mailing Address - Country:US
Mailing Address - Phone:307-322-3636
Mailing Address - Fax:307-322-5720
Practice Address - Street 1:201 14TH ST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-3201
Practice Address - Country:US
Practice Address - Phone:307-322-3636
Practice Address - Fax:307-322-5720
Is Sole Proprietor?:No
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY15133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered