Provider Demographics
NPI:1831184514
Name:COLLINSON, FEMIE (PA-C)
Entity type:Individual
Prefix:
First Name:FEMIE
Middle Name:
Last Name:COLLINSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:FEMIE
Other - Middle Name:
Other - Last Name:EBREO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4967 CROOKS RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-5801
Mailing Address - Country:US
Mailing Address - Phone:248-952-1601
Mailing Address - Fax:248-952-1614
Practice Address - Street 1:4967 CROOKS RD
Practice Address - Street 2:SUITE 130
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-5801
Practice Address - Country:US
Practice Address - Phone:248-952-1601
Practice Address - Fax:248-952-1614
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001996363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q17072Medicare UPIN
MIP28070053Medicare PIN