Provider Demographics
NPI:1245610658
Name:DIAZ, ALWIN A (NP)
Entity Type:Individual
Prefix:
First Name:ALWIN
Middle Name:A
Last Name:DIAZ
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:1675 N BARKER RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-5200
Mailing Address - Country:US
Mailing Address - Phone:414-755-4898
Mailing Address - Fax:262-754-0067
Practice Address - Street 1:7201 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-3532
Practice Address - Country:US
Practice Address - Phone:262-432-2352
Practice Address - Fax:262-697-5616
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2016-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI6367-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner