Provider Demographics
NPI:1649876145
Name:ADAMS-KOLTES, DEBRA L (RN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:ADAMS-KOLTES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5322 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-2595
Mailing Address - Country:US
Mailing Address - Phone:218-724-2800
Mailing Address - Fax:218-724-8200
Practice Address - Street 1:5322 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2595
Practice Address - Country:US
Practice Address - Phone:218-724-2800
Practice Address - Fax:218-724-8200
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR127441-1364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health