Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 2018019430 | MO |
N | 208000000X | Pediatrician | 65720 | TX |
NPI | 1013062256 |
---|---|
Provider Name | Angelia D Collins |
First Address | Lees Summit, MO 64086-5849 |
Second Address | Lees Summit, MO 64086-5849 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 04/09/2020 |