Individual
MS. COLLEEN R. BALLBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
9000 W WISCONSIN AVE, PEDIATRIC PALLIATIVE CARE, MILWAUKEE, WI 53226-4874
(414) 266-6469
(414) 266-1761
Mailing address
CHILDREN'S SPECIALTY GROUP-CHILDREN'S WISCONSIN MILWAUK, 9000 W WISCONSIN AVE, MILWAUKEE, WI 53226-4874
(414) 266-3339
(414) 266-3735
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
144887
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
3704-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790930006
—
WI
Enumeration date
12/01/2008
Last updated
08/27/2024
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