Healthcare Provider Details

I. General information

NPI: 1568945509
Provider Name (Legal Business Name): KATHERINE ANN COLLINS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S PARK ST
MADISON WI
53715-1507
US

IV. Provider business mailing address

W7440 STATE ROAD 39
NEW GLARUS WI
53574-8902
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-6000
  • Fax:
Mailing address:
  • Phone: 847-363-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.434072
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number290.018164
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11331-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: