MEDICARE: MR. COLLIN PERRY MCDOWELL RN, PHN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	2494536	MN

General Provider Information

NPI Number	:	1417690785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. COLLIN PERRY MCDOWELL RN, PHN

Provider Business Mailing Address
First Line	:	3555 WILLOW CREEK BLVD
Second Line	:	SUITE 290
City	:	VADNAIS HEIGHTS
State	:	MN
Zip	:	55110
Country	:	US
Telephone Number	:	952-431-5330
Fax Number	:	952-431-5334

Provider Business Practice Location Address
First Line	:	3555 WILLOW CREEK BLVD
Second Line	:	SUITE 290
City	:	VADNAIS HEIGHTS
State	:	MN
Zip	:	55110
Country	:	US
Telephone Number	:	952-431-5330
Fax Number	:	952-431-5334

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2022
Last Update Date	:	01/22/2026

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