Provider Demographics
NPI:1538113451
Name:TREVINO, COLLEEN M (NP)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:M
Last Name:TREVINO
Suffix:
Gender:F
Credentials:NP
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:TRAUMA AND CRITICAL CARE SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-8649
Mailing Address - Fax:414-805-8641
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:TRAUMA AND CRITICAL CARE SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-8649
Practice Address - Fax:414-805-8641
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI1922363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
007000261IOtherHUMANA
WI1538113451Medicaid
WI1538113451Medicaid
WI013A 73-601Medicare PIN