Provider Demographics
NPI:1902264708
Name:COLLINS, MONTIKA ADHANA (BSN, RN, CLC, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:MONTIKA
Middle Name:ADHANA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:BSN, RN, CLC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140241
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-0003
Mailing Address - Country:US
Mailing Address - Phone:918-398-3586
Mailing Address - Fax:
Practice Address - Street 1:2801 E KENOSHA ST
Practice Address - Street 2:#140241
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-6717
Practice Address - Country:US
Practice Address - Phone:918-398-3586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106766163WL0100X, 163W00000X, 163WM0102X, 163WN0002X, 163WN0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk