Provider Demographics
NPI:1750594917
Name:WEHMEYER, COLLEEN KELLY (NP)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:KELLY
Last Name:WEHMEYER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W138N6555 MANOR HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-6000
Mailing Address - Country:US
Mailing Address - Phone:262-565-8029
Mailing Address - Fax:
Practice Address - Street 1:302 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5904
Practice Address - Country:US
Practice Address - Phone:414-271-8045
Practice Address - Fax:414-431-0185
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101482-030363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner