Provider Demographics
NPI:1700528718
Name:DEURA, MINDY MAY (BSN, RN, CDCES)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:MAY
Last Name:DEURA
Suffix:
Gender:F
Credentials:BSN, RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 BRIAR HILL DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2749
Mailing Address - Country:US
Mailing Address - Phone:262-993-7290
Mailing Address - Fax:
Practice Address - Street 1:N74W12501 LEATHERWOOD CT
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-4490
Practice Address - Country:US
Practice Address - Phone:414-777-5998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI169401-030163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator