Provider Demographics
NPI:1831948223
Name:COLLINS, DESIREE NICOLE
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:NICOLE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 E HIGH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2206
Mailing Address - Country:US
Mailing Address - Phone:937-441-9588
Mailing Address - Fax:
Practice Address - Street 1:1725 WRIGHT ST APT 6
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-1564
Practice Address - Country:US
Practice Address - Phone:937-441-7791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant