Provider Demographics
NPI:1386633980
Name:BIERKE-NELSON, DIANE LYNN (CGC)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LYNN
Last Name:BIERKE-NELSON
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 N 21ST ST E
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-6546
Mailing Address - Country:US
Mailing Address - Phone:218-310-0088
Mailing Address - Fax:
Practice Address - Street 1:420 E 1ST ST # 1S3W10
Practice Address - Street 2:DULUTH CLINIC
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1901
Practice Address - Country:US
Practice Address - Phone:218-786-3012
Practice Address - Fax:218-786-3274
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS