NPI 1972309987 · live from the CMS NPI Registry
Collaborative Care Consultants LLC
Nurse Practitioner, Pediatrics in Saint Paul, MN. National Provider Identifier 1972309987, active.
NPI record
| NPI | 1972309987 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Pediatrics 363LP0200X |
| Practice location | 1057 Grand Ave Fl 2, Saint Paul, MN 55105 |
| Practice phone | 651-384-1736 |
| Mailing address | 4734 Westminster Cir, Eagan, MN 55122 |
| Enumerated | February 20, 2025 |
| Last updated | July 18, 2025 |
| Authorized official | Gretchen Moen, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Pediatrics primary | 363LP0200X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.