Provider Demographics
NPI:1912727298
Name:COLLINS, JOHN L
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:COLLINS
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 1:14155 BEAVERCREEK RD APT 110
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4159
Mailing Address - Country:US
Mailing Address - Phone:503-562-0186
Mailing Address - Fax:
Practice Address - Street 1:14155 BEAVERCREEK RD APT 110
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4159
Practice Address - Country:US
Practice Address - Phone:503-562-0186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide