Healthcare Provider Details

I. General information

NPI: 1265832794
Provider Name (Legal Business Name): COLLEEN M BRASSINGTON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 S TAFT AVE
JEFFERSON WI
53549-1453
US

IV. Provider business mailing address

4 N 90TH AVE
YAKIMA WA
98908-1415
US

V. Phone/Fax

Practice location:
  • Phone: 920-675-1094
  • Fax: 920-675-1120
Mailing address:
  • Phone: 509-424-0592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number111574-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: