Provider Information for 1932471422
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SHELLY COLLINS
Sex: Female
NPI: 1932471422
Last Updated: 2024-10-25
Certification Date: 2024-10-25
Certification Date: 2024-10-25
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1932471422 | ||||||||||||
| Enumeration Date | 2012-01-31 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 231 E FORSTER LN MUSTANG, OK 73064-4030 United States Phone: 405-694-6714 | Fax: | ||||||||||||
| Primary Practice Address | 231 E FORSTER LN MUSTANG, OK 73064-4030 United States Phone: 405-694-6714 | Fax: | ||||||||||||
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