Individual
COLLEEN KELLY DEL FAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
4555 W SCHROEDER DR, BROWN DEER, WI 53223-1475
(414) 355-9000
Mailing address
34700 VALLEY RD, OCONOMOWOC, WI 53066-4500
(262) 646-4411
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
174832-030
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
13528
WI
Other
Enumeration date
01/10/2023
Last updated
03/01/2023
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