Provider Demographics
NPI:1831556794
Name:COLLINS, PATRICIA J (LMT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N DOUGLAS HWY
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-9474
Mailing Address - Country:US
Mailing Address - Phone:907-209-5117
Mailing Address - Fax:
Practice Address - Street 1:174 S FRANKLIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1362
Practice Address - Country:US
Practice Address - Phone:907-209-5117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-24
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101177174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK101177OtherSTATE OF ALASKA OCCUPATIONAL LICENSE NUMBER