Provider Demographics
NPI:1346591484
Name:WHITE, DIANE F (RN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:F
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6992 COUNTY ROAD I
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:WI
Mailing Address - Zip Code:53039-9747
Mailing Address - Country:US
Mailing Address - Phone:920-296-8271
Mailing Address - Fax:
Practice Address - Street 1:W6992 COUNTY ROAD I
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:WI
Practice Address - Zip Code:53039-9747
Practice Address - Country:US
Practice Address - Phone:920-296-8271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI172352-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse