Provider Demographics
NPI:1194566562
Name:RADER, COLLIN EDWARD
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:EDWARD
Last Name:RADER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 WITTMER RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-7768
Mailing Address - Country:US
Mailing Address - Phone:567-307-5267
Mailing Address - Fax:
Practice Address - Street 1:1381 WITTMER RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-7768
Practice Address - Country:US
Practice Address - Phone:567-307-5267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-01
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker