Provider Demographics
NPI:1457509283
Name:WISNIESKI, DIANA MARIE (LPN/LPN-C/EMT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE
Last Name:WISNIESKI
Suffix:
Gender:F
Credentials:LPN/LPN-C/EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:DODGE
Mailing Address - State:NE
Mailing Address - Zip Code:68633-4222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:162 COUNTY ROAD 1
Practice Address - Street 2:
Practice Address - City:DODGE
Practice Address - State:NE
Practice Address - Zip Code:68633-4222
Practice Address - Country:US
Practice Address - Phone:402-693-2532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2123146N00000X
NE4198164W00000X
NE677 (LPN-C)164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic