Individual
MRS. MARY JO COLLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP C
Contact information
Practice address
12301 GRAPEFIELD RD, BASTIAN, VA 24314-4547
(276) 688-4331
(276) 688-4336
Mailing address
12301 GRAPEFIELD RD, BASTIAN, VA 24314-4547
(276) 688-4331
(276) 688-4336
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024165860
VA
363LF0000X
Family Nurse Practitioner
55352
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010053552
—
VA
05
—
7101185000
—
WV
Enumeration date
10/13/2006
Last updated
02/20/2014
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