Provider Demographics
NPI:1427788439
Name:LANGNESE, COLLEEN FRANCINE
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:FRANCINE
Last Name:LANGNESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 S 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-3725
Mailing Address - Country:US
Mailing Address - Phone:920-242-2822
Mailing Address - Fax:
Practice Address - Street 1:508 S 26TH ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-3725
Practice Address - Country:US
Practice Address - Phone:920-242-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI169363163W00000X
WI13040-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI169363OtherREGISTERED NURSE