Individual
MARY B KOOLMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Contact information
Practice address
347 SMITH AVE N, MS 70-302, SAINT PAUL, MN 55102-2387
(651) 220-6728
(651) 220-5231
Mailing address
347 N. SMITH AVE., MS 70-302, ST. PAUL, MN 55102
(651) 220-6728
(651) 220-5231
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
R44402
NM
363LP0200X
Pediatric Nurse Practitioner
Primary
R119628-5
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000Z8736
—
NM
Enumeration date
10/03/2006
Last updated
09/23/2014
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