Provider Demographics
NPI:1720513450
Name:FIUMEFREDDO, COLLEEN (LPN)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:FIUMEFREDDO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:BIGDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:704 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:53181-9693
Mailing Address - Country:US
Mailing Address - Phone:773-317-8822
Mailing Address - Fax:
Practice Address - Street 1:704 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:TWIN LAKES
Practice Address - State:WI
Practice Address - Zip Code:53181-9693
Practice Address - Country:US
Practice Address - Phone:773-317-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI321282-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse