Provider Demographics
NPI:1558378018
Name:FITZPATRICK, COLETTE JEAN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:COLETTE
Middle Name:JEAN
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 WATER AVE
Mailing Address - Street 2:PO BOX 175
Mailing Address - City:HILLSBORO
Mailing Address - State:WI
Mailing Address - Zip Code:54634-9049
Mailing Address - Country:US
Mailing Address - Phone:608-489-3473
Mailing Address - Fax:
Practice Address - Street 1:518 WATER AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:WI
Practice Address - Zip Code:54634-9049
Practice Address - Country:US
Practice Address - Phone:608-489-3473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI64121-030163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse