Provider Demographics
NPI:1811165764
Name:COLLINS, CHRISTINE (NP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-1328
Mailing Address - Country:US
Mailing Address - Phone:804-435-8570
Mailing Address - Fax:
Practice Address - Street 1:36 LIVELY OAKS RD
Practice Address - Street 2:
Practice Address - City:LIVELY
Practice Address - State:VA
Practice Address - Zip Code:22482-4054
Practice Address - Country:US
Practice Address - Phone:804-462-5155
Practice Address - Fax:804-462-5109
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA101723Medicare PIN