Provider Demographics
NPI:1053050328
Name:DICKMANN, CORINA MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:CORINA
Middle Name:MARIE
Last Name:DICKMANN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:CORINA
Other - Middle Name:MARIE
Other - Last Name:LEFFEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:118700 LUTHER ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54484-5274
Mailing Address - Country:US
Mailing Address - Phone:715-615-9286
Mailing Address - Fax:
Practice Address - Street 1:118700 LUTHER ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:WI
Practice Address - Zip Code:54484-5274
Practice Address - Country:US
Practice Address - Phone:715-615-9286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI241287163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI241287OtherNURSING LICENSE