Provider Demographics
NPI:1487087367
Name:COLLICK, CHINOR L JR (RN)
Entity type:Individual
Prefix:MR
First Name:CHINOR
Middle Name:L
Last Name:COLLICK
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LAVA CT
Mailing Address - Street 2:1-B
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-1944
Mailing Address - Country:US
Mailing Address - Phone:410-830-0878
Mailing Address - Fax:
Practice Address - Street 1:4 LAVA CT
Practice Address - Street 2:1-B
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-1944
Practice Address - Country:US
Practice Address - Phone:410-830-0878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR166940163W00000X, 163WA2000X, 163WC0400X, 163WC1400X, 163WC1500X, 163WC1600X, 163WC3500X, 163WD0400X, 163WG0000X, 163WI0600X, 163WM0705X, 163WN1003X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1400XNursing Service ProvidersRegistered NurseCollege Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WW0000XNursing Service ProvidersRegistered NurseWound Care