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NPI Code Detail

MEDICARE: COLLEEN ANNE KEANE-MULLOOLY RNC,MS,WHNP

MEDICARE: COLLEEN ANNE KEANE-MULLOOLY RNC,MS,WHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207VG0400XGynecology Physician2232-033WI
2363L00000XNurse Practitioner2232-33WI

General Provider Information

NPI Number : 1043255367
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLEEN ANNE KEANE-MULLOOLY RNC,MS,WHNP
Provider Business Mailing Address
First Line : 302 N JACKSON ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-5904
Country : US
Telephone Number : 608-347-2297
Fax Number :
Provider Business Practice Location Address
First Line : 302 N JACKSON ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-5904
Country : US
Telephone Number : 608-347-2297
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2006
Last Update Date : 12/30/2013

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