Provider Demographics
NPI:1770303166
Name:DIVINE-BIDDICK, CARA SUSAN (APNP)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:SUSAN
Last Name:DIVINE-BIDDICK
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 FILARDO CT
Mailing Address - Street 2:
Mailing Address - City:MINERAL POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53565-1734
Mailing Address - Country:US
Mailing Address - Phone:608-217-1937
Mailing Address - Fax:
Practice Address - Street 1:1250 E BUS HWY 151 STE D
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-3875
Practice Address - Country:US
Practice Address - Phone:608-470-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16044-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health