Provider Demographics
NPI:1538559216
Name:COLLIE, RAY JR
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:COLLIE
Suffix:JR
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 1:998 CARLISLE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-5909
Mailing Address - Country:US
Mailing Address - Phone:513-371-1447
Mailing Address - Fax:
Practice Address - Street 1:998 CARLISLE AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-5909
Practice Address - Country:US
Practice Address - Phone:513-371-1447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.146739164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse