Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 0024173933 | VA |
NPI | 1003363896 |
---|---|
Provider Name | Debra T. Collins |
First Address | Clover, VA 24534-3057 |
Second Address | Victoria, VA 23974-2624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2016 |
Last Update Date | 08/09/2016 |