Provider Demographics
NPI:1801175724
Name:COLLINS, ANITA SUE (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:SUE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 2400
Mailing Address - Street 2:
Mailing Address - City:DORA
Mailing Address - State:MO
Mailing Address - Zip Code:65637
Mailing Address - Country:US
Mailing Address - Phone:417-712-1705
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 2400
Practice Address - Street 2:
Practice Address - City:DORA
Practice Address - State:MO
Practice Address - Zip Code:65637-9305
Practice Address - Country:US
Practice Address - Phone:417-712-1705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042159164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse