MEDICARE: COLLINS MARANGA RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	2271497	MN

General Provider Information

NPI Number	:	1386216927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLINS MARANGA RN

Provider Business Mailing Address
First Line	:	25946 12TH ST W
Second Line	:
City	:	ZIMMERMAN
State	:	MN
Zip	:	55398-8584
Country	:	US
Telephone Number	:	763-232-3555
Fax Number	:

Provider Business Practice Location Address
First Line	:	3340 BROOKDALE DR N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55443-2863
Country	:	US
Telephone Number	:	763-280-3236
Fax Number	:	888-588-3166

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2021
Last Update Date	:	07/13/2021

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