Provider Demographics
NPI:1003523705
Name:COLWELL, CALLIE (RN)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:COLWELL
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 1:3825 39TH AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-2043
Mailing Address - Country:US
Mailing Address - Phone:629-465-7522
Mailing Address - Fax:
Practice Address - Street 1:3825 39TH AVE STE 120
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-2043
Practice Address - Country:US
Practice Address - Phone:629-465-7522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI259034163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)