Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 161187 | NY |
NPI | 1154608305 |
---|---|
Provider Name | Dr. Joanne Collinge |
First Address | Zihuatanejo, GRO 40880 |
Second Address | Zihuatanejo, GRO 40880 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2011 |
Last Update Date | 15/11/2011 |