Healthcare Provider Details

I. General information

NPI: 1265346100
Provider Name (Legal Business Name): COLLEEN LYNN ORDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8503 178TH LN NE
FOREST LAKE MN
55025-8351
US

IV. Provider business mailing address

8503 178TH LN NE
FOREST LAKE MN
55025-8351
US

V. Phone/Fax

Practice location:
  • Phone: 651-387-1697
  • Fax: 651-464-8674
Mailing address:
  • Phone:
  • Fax: 651-464-8674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: