Individual
MS. NICOLE MCCOLLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 254-3456
Mailing address
900 PEELER ST, KALAMAZOO, MI 49008-2300
(269) 345-8618
(269) 345-1508
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704271330
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790
MINNESOTA LICENSE
MN
01
—
4704271330
MI STATE LICENSE
MI
Enumeration date
09/22/2009
Last updated
01/05/2022
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