Provider Demographics
NPI:1699259085
Name:COLLINS-TUNSTILL, NICOLE (222Q00000X)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:COLLINS-TUNSTILL
Suffix:
Gender:F
Credentials:222Q00000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 GRADISON DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-2055
Mailing Address - Country:US
Mailing Address - Phone:317-717-2887
Mailing Address - Fax:
Practice Address - Street 1:2244 GRADISON DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-2055
Practice Address - Country:US
Practice Address - Phone:317-717-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist