Individual
MAE KOLLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
3007 THOMAS AVE N, MINNEAPOLIS, MN 55411-1034
(612) 886-2131
Mailing address
5775 WAYZATA BLVD, ST LOUIS PARK, MN 55416-1222
(612) 886-2131
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
348032
CLASS A PROFESSIONAL HOME HEALTH CARE AGENCY
MN
Enumeration date
08/28/2010
Last updated
08/28/2010
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