Provider Demographics
NPI:1548236763
Name:COLLMANN, GWEN ELIZABETH (RN, MSN, CPNP)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:ELIZABETH
Last Name:COLLMANN
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11801 MIRA MESA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-2135
Mailing Address - Country:US
Mailing Address - Phone:512-266-8747
Mailing Address - Fax:
Practice Address - Street 1:12174 NORTH MOPAC
Practice Address - Street 2:SUITE A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758
Practice Address - Country:US
Practice Address - Phone:512-833-7334
Practice Address - Fax:512-833-7333
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX629383363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B2640Medicare ID - Type Unspecified
TXQ00820Medicare UPIN