Provider Demographics
NPI:1366467235
Name:MATEL, DIANE (APNP, PHD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MATEL
Suffix:
Gender:F
Credentials:APNP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 W GLEN OAKS LN STE 1
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3477
Mailing Address - Country:US
Mailing Address - Phone:262-241-8100
Mailing Address - Fax:262-241-8200
Practice Address - Street 1:1045 W GLEN OAKS LN STE 1
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3477
Practice Address - Country:US
Practice Address - Phone:262-241-8100
Practice Address - Fax:262-241-8200
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI442363LP0808X
103T00000X
WI1831-057103T00000X, 103TH0100X
WI1838-057103TF0000X
WI442-033364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39401900Medicaid
WI39401900Medicaid