Provider Demographics
NPI:1629419882
Name:KOLLES, BRITTANY MARIE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MARIE
Last Name:KOLLES
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:MARIE
Other - Last Name:WEDDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:25 1ST AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1598
Mailing Address - Country:US
Mailing Address - Phone:763-682-3005
Mailing Address - Fax:763-682-3006
Practice Address - Street 1:25 1ST AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1598
Practice Address - Country:US
Practice Address - Phone:763-682-3005
Practice Address - Fax:763-682-3006
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 200140-5163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse