Provider Demographics
NPI:1912615725
Name:COLLINS, RHONDA RENEE
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:RENEE
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 1:550 E DEVON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143-2639
Mailing Address - Country:US
Mailing Address - Phone:864-625-3376
Mailing Address - Fax:
Practice Address - Street 1:2135 CITY GATE LN STE 350
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3092
Practice Address - Country:US
Practice Address - Phone:864-625-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.026300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily