Provider Demographics
NPI:1790719680
Name:ERDMANN, COLLEEN A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:A
Last Name:ERDMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 N 15TH ST.
Mailing Address - Street 2:MARQUETTE UNIVERSITY STUDENT HEALTH SERVICE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233
Mailing Address - Country:US
Mailing Address - Phone:414-288-7184
Mailing Address - Fax:414-288-5732
Practice Address - Street 1:545 N. 15TH ST.
Practice Address - Street 2:MARQUETTE UNIVERSITY STUDENT HEALTH SERVICE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53154
Practice Address - Country:US
Practice Address - Phone:414-288-7184
Practice Address - Fax:414-288-5732
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1352-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41959400Medicaid
WI0050-32350Medicare ID - Type Unspecified
WI41959400Medicaid
P75826Medicare UPIN