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General NPI Number Information
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NPI Number | 1801592720
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Entity Type | Individual
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Provider Name | MICHELLE ROSE COLLINS
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Gender | Female
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Dates
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Enumeration Date | 02/02/2023
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 450 EASTVOLD AVE
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City | ORTONVILLE
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State | MN
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Zip | 56278-1133
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Country | US
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Telephone | 507-858-1210
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Fax |
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Provider Business Mailing Address
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Address Line | 48496 141ST ST
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City | BIG STONE CITY
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State | SD
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Zip | 57216-8209
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Country | US
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Telephone | 507-858-1210
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 9896
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License Number State | MN
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