Healthcare Provider Details

I. General information

NPI: 1417690785
Provider Name (Legal Business Name): COLLIN PERRY MCDOWELL RN, PHN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: COLLIN PERRY ERNSTE-MCDOWELL RN, PHN

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 77TH ST W APT 547
EDINA MN
55435-4239
US

IV. Provider business mailing address

4660 77TH ST W APT 547
EDINA MN
55435-4239
US

V. Phone/Fax

Practice location:
  • Phone: 763-688-0517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2494536
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: