Provider Demographics
NPI:1669042800
Name:HENZE, DIANA RENEE (RN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:RENEE
Last Name:HENZE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W STOCKMAN ST
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54028-9592
Mailing Address - Country:US
Mailing Address - Phone:715-441-1914
Mailing Address - Fax:
Practice Address - Street 1:201 W STOCKMAN ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:WI
Practice Address - Zip Code:54028-9592
Practice Address - Country:US
Practice Address - Phone:715-441-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI200881-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse