Provider Demographics
NPI:1689093783
Name:KOLANDER, MICARA LOUISE
Entity Type:Individual
Prefix:MRS
First Name:MICARA
Middle Name:LOUISE
Last Name:KOLANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICARA
Other - Middle Name:LOUISE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1305 W 18TH ST
Mailing Address - Street 2:PO BOX 5074
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WINDOM AREA HOSPITAL
Practice Address - Street 2:2150 HOSPITAL DR
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101
Practice Address - Country:US
Practice Address - Phone:507-831-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCR000847367500000X
MN2108845367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered