Individual
ETHAN COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
208W FRONT STREET, COEBURN, VA 24230
(276) 455-5556
Mailing address
PO BOX 90, COEBURN, VA 24230-0090
(276) 455-5556
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
0001238326
VA
363LF0000X
Family Nurse Practitioner
Primary
0024183385
VA
Other
Enumeration date
05/17/2021
Last updated
02/23/2022
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