Provider Demographics
NPI:1023086402
Name:THEUNE, DORIS U (MS RN CS)
Entity type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:U
Last Name:THEUNE
Suffix:
Gender:F
Credentials:MS RN CS
Other - Prefix:MS
Other - First Name:DORIS
Other - Middle Name:
Other - Last Name:UHLIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS RN
Mailing Address - Street 1:2920 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-1944
Mailing Address - Country:US
Mailing Address - Phone:920-453-5414
Mailing Address - Fax:920-803-2990
Practice Address - Street 1:2920 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1944
Practice Address - Country:US
Practice Address - Phone:920-453-5414
Practice Address - Fax:920-803-2990
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI249033363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43931900Medicaid
WI43931900Medicaid