Provider Demographics
NPI:1609699735
Name:COLLINS, HEATHER NICOLE
Entity type:Individual
Prefix:
First Name:HEATHER
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 1:128 HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:WV
Mailing Address - Zip Code:25984
Mailing Address - Country:US
Mailing Address - Phone:304-663-8648
Mailing Address - Fax:
Practice Address - Street 1:128 HONEYSUCKLE LN
Practice Address - Street 2:
Practice Address - City:RUPERT
Practice Address - State:WV
Practice Address - Zip Code:25984
Practice Address - Country:US
Practice Address - Phone:304-663-8648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant