Provider Demographics
NPI:1548941636
Name:COLLINS, CALLIE JO
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:JO
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-8931
Mailing Address - Country:US
Mailing Address - Phone:740-258-7712
Mailing Address - Fax:
Practice Address - Street 1:224 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-8931
Practice Address - Country:US
Practice Address - Phone:740-258-7712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker