Healthcare Provider Details

I. General information

NPI: 1184528416
Provider Name (Legal Business Name): COLE FAHEY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 FRANCE AVE S
EDINA MN
55435-3400
US

IV. Provider business mailing address

7500 FRANCE AVE S
EDINA MN
55435-3400
US

V. Phone/Fax

Practice location:
  • Phone: 651-999-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2516193
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: