Provider Demographics
NPI:1366452005
Name:TOTERO, COLLEEN M (NP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:TOTERO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:262-652-0500
Mailing Address - Fax:262-652-1928
Practice Address - Street 1:5923 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-3737
Practice Address - Country:US
Practice Address - Phone:262-652-0500
Practice Address - Fax:262-652-1928
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1552363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43931500Medicaid