Provider Demographics
NPI:1578705604
Name:DIKANOVIC, LUANNE MARIE (RNC, NNP)
Entity Type:Individual
Prefix:MRS
First Name:LUANNE
Middle Name:MARIE
Last Name:DIKANOVIC
Suffix:
Gender:F
Credentials:RNC, NNP
Other - Prefix:MISS
Other - First Name:LUANNE
Other - Middle Name:MARIE
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNC, NNP
Mailing Address - Street 1:10400 75TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7884
Mailing Address - Country:US
Mailing Address - Phone:262-948-5754
Mailing Address - Fax:
Practice Address - Street 1:10400 75TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7884
Practice Address - Country:US
Practice Address - Phone:262-948-5754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI92622-030163WN0002X
WI1162363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care