Provider Demographics
NPI:1861849820
Name:FRALEY, COLLEEN (APNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:FRALEY
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:HERDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:668 MARATECH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:WI
Mailing Address - Zip Code:54448-9008
Mailing Address - Country:US
Mailing Address - Phone:888-885-4434
Mailing Address - Fax:
Practice Address - Street 1:6400 INDUSTRIAL LOOP
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-2452
Practice Address - Country:US
Practice Address - Phone:414-423-4100
Practice Address - Fax:414-423-4134
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6951-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily