Provider Demographics
NPI:1417321829
Name:COLLIGAN, PAUL ALLEN (DNP, CRNA, APRN, PHN)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ALLEN
Last Name:COLLIGAN
Suffix:
Gender:M
Credentials:DNP, CRNA, APRN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19571 SUNRISE CT
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4841
Mailing Address - Country:US
Mailing Address - Phone:602-790-0617
Mailing Address - Fax:
Practice Address - Street 1:19571 SUNRISE CT
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4841
Practice Address - Country:US
Practice Address - Phone:602-790-0617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-23
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR189295-8367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered