Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 036-126671 | IL |
N | 2080P0210X | Pediatric Nephrologist | 036.114910 | IL |
NPI | 1730373895 |
---|---|
Provider Name | Katherine Louise Collins |
First Address | Quincy, IL 62301-4038 |
Second Address | Quincy, IL 62301-4038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2007 |
Last Update Date | 11/02/2013 |