1417690785 NPI number — MR. COLLIN PERRY MCDOWELL RN, PHN

Table of content: MR. COLLIN PERRY MCDOWELL RN, PHN (NPI 1417690785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417690785 NPI number — MR. COLLIN PERRY MCDOWELL RN, PHN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDOWELL
Provider First Name:
COLLIN
Provider Middle Name:
PERRY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RN, PHN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ERNSTE-MCDOWELL
Provider Other First Name:
COLLIN
Provider Other Middle Name:
PERRY
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, PHN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417690785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3555 WILLOW CREEK BLVD
Provider Second Line Business Practice Location Address:
SUITE 290
Provider Business Practice Location Address City Name:
VADNAIS HEIGHTS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-431-5330
Provider Business Practice Location Address Fax Number:
952-431-5334
Provider Enumeration Date:
04/15/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  2494536 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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