Provider Demographics
NPI:1013755214
Name:MCCOLLUM, ANDREA CRYSTAL (RD, LDN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CRYSTAL
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 4TH AVE S STE 5010
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1053
Mailing Address - Country:US
Mailing Address - Phone:304-215-1678
Mailing Address - Fax:
Practice Address - Street 1:310 4TH AVE S STE 5010
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1053
Practice Address - Country:US
Practice Address - Phone:304-215-1678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-20
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered