Healthcare Provider Details

I. General information

NPI: 1518072255
Provider Name (Legal Business Name): KATHLEEN M. COLELLA ANP-BC, MSN, CURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE UROLOGY CLINIC, JESSE BROWN VA MEDICAL CENTER
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-8387
  • Fax: 312-569-7253
Mailing address:
  • Phone: 847-570-2040
  • Fax: 847-733-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209005593
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209-005593
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: