Healthcare Provider Details

I. General information

NPI: 1912105388
Provider Name (Legal Business Name): JANE ANNE COLEMAN WHC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N JACKSON ST
MILWAUKEE WI
53202-5904
US

IV. Provider business mailing address

1506 APRICOT CT.
GREENDALE WI
53129
US

V. Phone/Fax

Practice location:
  • Phone: 414-271-8045
  • Fax: 441-427-2238
Mailing address:
  • Phone: 414-423-8744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number50974-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: