Healthcare Provider Details

I. General information

NPI: 1548236763
Provider Name (Legal Business Name): GWEN ELIZABETH COLLMANN RN, MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12174 NORTH MOPAC SUITE A
AUSTIN TX
78758
US

IV. Provider business mailing address

11801 MIRA MESA DR
AUSTIN TX
78732-2135
US

V. Phone/Fax

Practice location:
  • Phone: 512-833-7334
  • Fax: 512-833-7333
Mailing address:
  • Phone: 512-266-8747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number629383
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: