Healthcare Provider Details

I. General information

NPI: 1083536841
Provider Name (Legal Business Name): STEPHANIE R COLON APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15430 W CAPITOL DR STE 100
BROOKFIELD WI
53005-2626
US

IV. Provider business mailing address

8144 RACINE AVE
WIND LAKE WI
53185-1438
US

V. Phone/Fax

Practice location:
  • Phone: 262-235-3115
  • Fax:
Mailing address:
  • Phone: 414-530-4502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number18629-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: