Provider Demographics
NPI:1477213841
Name:DORN, ROBIN DENE (RN)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:DENE
Last Name:DORN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:DENE
Other - Last Name:SIBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:N6987 CTH Q
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-9606
Mailing Address - Country:US
Mailing Address - Phone:361-442-4849
Mailing Address - Fax:
Practice Address - Street 1:1515 HOMMEN RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:WI
Practice Address - Zip Code:53531-9678
Practice Address - Country:US
Practice Address - Phone:361-442-4849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI233487-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health