1194559310 NPI number — JULIA COLLINS CARE COORDINATOR

Table of content: JULIA COLLINS CARE COORDINATOR (NPI 1194559310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194559310 NPI number — JULIA COLLINS CARE COORDINATOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
JULIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CARE COORDINATOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194559310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
328 BRYANT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KETCHIKAN
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99901-5538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-514-4108
Provider Business Mailing Address Fax Number:
888-925-8338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 MAIN ST.
Provider Second Line Business Practice Location Address:
#211
Provider Business Practice Location Address City Name:
KETCHIKAN
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-514-4108
Provider Business Practice Location Address Fax Number:
888-925-8338
Provider Enumeration Date:
08/29/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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