Healthcare Provider Details

I. General information

NPI: 1194353763
Provider Name (Legal Business Name): TIFFANY DAHLKE APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W2654 COUNTY ROAD KK
APPLETON WI
54915-9468
US

IV. Provider business mailing address

PO BOX 365
ONEIDA WI
54155-0365
US

V. Phone/Fax

Practice location:
  • Phone: 920-830-2221
  • Fax:
Mailing address:
  • Phone: 920-869-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9965-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: