Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mariah M Collicott, NP

Individual provider Family Nurse Practitioner · NPI 1568185403

Mariah M Collicott, NP is a Nurse Practitioner in Waukesha, Wisconsin. Qualified in 2022, 4 years ago. Practices with Cleanslate Medical Group of Wisconsin SC, a 28-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Wisconsin.

Years since qualifying
4
Licensed in
WI
In the registry since
2022
Specialties on file
2
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

20611 Watertown Rd Ste E
Waukesha, WI 53186-1871
Phone: (629) 014-4502
Fax: (262) 901-4451
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1061 E Commerce Blvd, Slinger, WI 53086-9326 — (262) 644-2900

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 13169-33 (WI)
Nurse Practitioner Taxonomy 363L00000X · Licence 13169-33 (WI)

Record details

NPI number1568185403
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP
Sole proprietorNo
NPI enumeratedSeptember 26, 2022
Last updated in NPPESAugust 5, 2025
Certification dateAugust 5, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Cleanslate Medical Group Of Wisconsin Sc — 28 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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