Provider Demographics
NPI:1710079231
Name:MICELE, COLLEEN K (FNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:K
Last Name:MICELE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 W. FDL STREET
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-9288
Mailing Address - Country:US
Mailing Address - Phone:920-745-4700
Mailing Address - Fax:920-745-4701
Practice Address - Street 1:1242 W FOND DU LAC ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-9288
Practice Address - Country:US
Practice Address - Phone:920-745-4700
Practice Address - Fax:920-745-4701
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2935363LF0000X
WI2935-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily