Provider Demographics
NPI:1679728992
Name:MAYR, DIANNE MARY (RN,BSN)
Entity Type:Individual
Prefix:MISS
First Name:DIANNE
Middle Name:MARY
Last Name:MAYR
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:MRS
Other - First Name:DIANNE
Other - Middle Name:MARY
Other - Last Name:KASMISKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 82
Mailing Address - Street 2:209 LINCOLN AVE APT. 1A
Mailing Address - City:RIO
Mailing Address - State:WI
Mailing Address - Zip Code:53960-0082
Mailing Address - Country:US
Mailing Address - Phone:920-763-5606
Mailing Address - Fax:
Practice Address - Street 1:3181 NATURE DR
Practice Address - Street 2:CONSERVANCY STATES LN
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590
Practice Address - Country:US
Practice Address - Phone:608-837-7219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11740-030163W00000X, 163WC2100X, 163WG0100X, 163WH0200X, 163WI0600X, 163WP0200X, 163WR0400X, 163WW0000X, 163WX1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35056500Medicaid