Provider Demographics
NPI:1831965342
Name:STAGE, COLLIN BARRETT MERCURI
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:BARRETT MERCURI
Last Name:STAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 HOUSTON CT
Mailing Address - Street 2:
Mailing Address - City:HAW RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:27258-8853
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:808 HOUSTON CT
Practice Address - Street 2:
Practice Address - City:HAW RIVER
Practice Address - State:NC
Practice Address - Zip Code:27258-8853
Practice Address - Country:US
Practice Address - Phone:315-720-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC302079163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse