Provider Demographics
NPI:1093395311
Name:COLLINS, SHAMUS (NREMT)
Entity Type:Individual
Prefix:
First Name:SHAMUS
Middle Name:
Last Name:COLLINS
Suffix:
Gender:M
Credentials:NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SAINT OLAF AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-1574
Mailing Address - Country:US
Mailing Address - Phone:651-447-4465
Mailing Address - Fax:
Practice Address - Street 1:1500 SAINT OLAF AVE
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-1574
Practice Address - Country:US
Practice Address - Phone:651-447-4465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1005136146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic