Provider Demographics
NPI:1649593310
Name:COINDREAU, ALLISON REBECCA (RN, CNM, MS)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:REBECCA
Last Name:COINDREAU
Suffix:
Gender:F
Credentials:RN, CNM, MS
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:STITSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:PO BOX 1309 MAIL STOP 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2635 UNIVERSITY AVE W STE 160
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1271
Practice Address - Country:US
Practice Address - Phone:651-254-3500
Practice Address - Fax:651-254-2579
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2296456363L00000X
TX776583367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212306901Medicaid