Individual
MS. TERRY A KOLLENBROICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
818 FOREST LN, WATERFORD, WI 53185-4585
(262) 514-3700
(262) 514-3867
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-6250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2373
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39847700
—
WI
Enumeration date
05/15/2006
Last updated
10/21/2024
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