Mary B Koolmo, APRN, CNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

R119628-5 Issued in MN

Practice address

347 Smith Ave N
Ms 70-302
Saint Paul, MN 55102-2387

Phone

(651) 220-6728

Fax

(651) 220-5231

NPI assigned

Oct 3, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Mary B Dentz Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411430400000",
    "number": "1821182296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "347 N. SMITH AVE.",
            "address_2": "MS 70-302",
            "city": "ST. PAUL",
            "state": "MN",
            "postal_code": "55102",
            "telephone_number": "651-220-6728",
            "fax_number": "651-220-5231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "347 SMITH AVE N",
            "address_2": "MS 70-302",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551022387",
            "telephone_number": "651-220-6728",
            "fax_number": "651-220-5231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOLMO",
        "first_name": "MARY",
        "middle_name": "B",
        "credential": "APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2014-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NM",
            "license": "R44402",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MN",
            "license": "R119628-5",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000Z8736",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "DENTZ",
            "middle_name": "B",
            "credential": "CPNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laurie D Koltes, MA, LP
• Craig M Kompelien, CRNA
• Rohee Njell-Tepe Konde
• Laticia Kondrasuk, CRNA
• Tou Su Taylor Kong
• Steven Early Koop, MD
• Hannah Rachel Kopel
• Elizabeth Kopf, MA CCC-SLP
• Richard A Kopher, MD
• Leslie A Kopietz, MD

• Pediatric Nurse Practitioner in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Pediatric Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.