Healthcare Provider Details

I. General information

NPI: 1790831014
Provider Name (Legal Business Name): CAROL A HEUPEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL A COLLINS RN

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 HORIZON DR
BURNSVILLE MN
55337-3091
US

IV. Provider business mailing address

16414 GRINNELL AVE
LAKEVILLE MN
55044-9061
US

V. Phone/Fax

Practice location:
  • Phone: 952-890-0940
  • Fax:
Mailing address:
  • Phone: 352-666-7349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR040988-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: