1881566776 NPI number — LAFLORENCE MERRILLE COLLINS CNA

Table of content: LAFLORENCE MERRILLE COLLINS CNA (NPI 1881566776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881566776 NPI number — LAFLORENCE MERRILLE COLLINS CNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
LAFLORENCE
Provider Middle Name:
MERRILLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLLINS
Provider Other First Name:
LAFLORENCE
Provider Other Middle Name:
MERRILLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1881566776
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 W BROWN DEER RD UNIT G-603
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYSIDE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53217-2372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-993-9556
Provider Business Mailing Address Fax Number:
775-640-6832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9011 N 86TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53224-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-993-9556
Provider Business Practice Location Address Fax Number:
775-640-6832
Provider Enumeration Date:
09/19/2025

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: 376K00000X , with the licence number:  148760 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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