Provider Demographics
NPI:1720387913
Name:COLTON, MIRIAM
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:
Last Name:COLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 W MITCHELL ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-1748
Mailing Address - Country:US
Mailing Address - Phone:414-643-5755
Mailing Address - Fax:414-643-5780
Practice Address - Street 1:4111 W MITCHELL ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-1748
Practice Address - Country:US
Practice Address - Phone:414-643-5755
Practice Address - Fax:414-643-5780
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4368-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner