Healthcare Provider Details

I. General information

NPI: 1376211128
Provider Name (Legal Business Name): MEGAN JUDE COLLINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2021
Last Update Date: 09/04/2021
Certification Date: 09/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 6TH ST E
SAINT PAUL MN
55106-5124
US

IV. Provider business mailing address

770 6TH ST E
SAINT PAUL MN
55106-5124
US

V. Phone/Fax

Practice location:
  • Phone: 608-556-5711
  • Fax:
Mailing address:
  • Phone: 608-556-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number191557-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: