Provider Demographics
NPI:1750578290
Name:ROSEN, COLEEN W (FNP)
Entity type:Individual
Prefix:MS
First Name:COLEEN
Middle Name:W
Last Name:ROSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:COLEEN
Other - Middle Name:M
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC UROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-337-7314
Mailing Address - Fax:414-266-1752
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC UROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-337-7314
Practice Address - Fax:414-266-1752
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI80424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1750578290Medicaid
WI68086 0816Medicare PIN
WI1750578290Medicaid