Provider Demographics
NPI:1528682374
Name:ROSS, MAURA COLLINS (CNP)
Entity type:Individual
Prefix:DR
First Name:MAURA
Middle Name:COLLINS
Last Name:ROSS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MAURA
Other - Middle Name:FRANCES
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3301 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-4516
Mailing Address - Country:US
Mailing Address - Phone:651-431-5181
Mailing Address - Fax:
Practice Address - Street 1:1045 STOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2149
Practice Address - Country:US
Practice Address - Phone:952-974-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-07
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7447363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health