Provider Demographics
NPI:1902184526
Name:NELSON, DIANE M
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3153 HWY 164
Mailing Address - Street 2:
Mailing Address - City:SLINGER
Mailing Address - State:WI
Mailing Address - Zip Code:53086-9724
Mailing Address - Country:US
Mailing Address - Phone:262-224-5148
Mailing Address - Fax:
Practice Address - Street 1:3153 HWY 164
Practice Address - Street 2:
Practice Address - City:SLINGER
Practice Address - State:WI
Practice Address - Zip Code:53086-9724
Practice Address - Country:US
Practice Address - Phone:262-224-5148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-31
Last Update Date:2011-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula