Provider Demographics
NPI:1861441958
Name:DAFFINSON, DIANE E (RN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:E
Last Name:DAFFINSON
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:N22544 MCCONNELL LN
Mailing Address - Street 2:
Mailing Address - City:ETTRICK
Mailing Address - State:WI
Mailing Address - Zip Code:54627-9201
Mailing Address - Country:US
Mailing Address - Phone:608-525-5026
Mailing Address - Fax:
Practice Address - Street 1:N22544 MCCONNELL LN
Practice Address - Street 2:
Practice Address - City:ETTRICK
Practice Address - State:WI
Practice Address - Zip Code:54627-9201
Practice Address - Country:US
Practice Address - Phone:608-525-5026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38283600Medicaid