Healthcare Provider Details

I. General information

NPI: 1891808242
Provider Name (Legal Business Name): COLLEEN MARX N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LAKEFRONT WAY
TWO RIVERS WI
54241-3301
US

IV. Provider business mailing address

800 LAKEFRONT WAY
TWO RIVERS WI
54241-3301
US

V. Phone/Fax

Practice location:
  • Phone: 920-320-2436
  • Fax: 920-320-5187
Mailing address:
  • Phone: 920-320-2436
  • Fax: 920-320-5187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2149
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: