Healthcare Provider Details

I. General information

NPI: 1598065054
Provider Name (Legal Business Name): COLLEEN MARGARET ZIMMER RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 MONTREAL AVE STE 107
SAINT PAUL MN
55116-2393
US

IV. Provider business mailing address

1150 MONTREAL AVE STE 107
SAINT PAUL MN
55116-2393
US

V. Phone/Fax

Practice location:
  • Phone: 651-313-8080
  • Fax: 651-925-0610
Mailing address:
  • Phone: 651-313-8080
  • Fax: 651-925-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR143245-7
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number270
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: