Healthcare Provider Details

I. General information

NPI: 1285860213
Provider Name (Legal Business Name): KOLLEEN ANN AMON NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

IV. Provider business mailing address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

V. Phone/Fax

Practice location:
  • Phone: 763-873-3000
  • Fax: 612-873-1928
Mailing address:
  • Phone: 763-873-3000
  • Fax: 612-873-1928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberR1441422
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: