=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912105388
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANE ANNE COLEMAN WHC NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 302 N JACKSON ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53202-5904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-271-8045
-----------------------------------------------------
Fax | 441-427-2238
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1506 APRICOT CT.
-----------------------------------------------------
City | GREENDALE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-423-8744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | 50974-030
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------