Healthcare Provider Details

I. General information

NPI: 1649876145
Provider Name (Legal Business Name): DEBRA L ADAMS-KOLTES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5322 GRAND AVE
DULUTH MN
55807-2595
US

IV. Provider business mailing address

5322 GRAND AVE
DULUTH MN
55807-2595
US

V. Phone/Fax

Practice location:
  • Phone: 218-724-2800
  • Fax: 218-724-8200
Mailing address:
  • Phone: 218-724-2800
  • Fax: 218-724-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberR127441-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: