Healthcare Provider Details

I. General information

NPI: 1033689443
Provider Name (Legal Business Name): DIANE J ANDERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 WOODHAVEN CT
CAMBRIDGE WI
53523-8604
US

IV. Provider business mailing address

604 WOODHAVEN CT
CAMBRIDGE WI
53523-8604
US

V. Phone/Fax

Practice location:
  • Phone: 608-469-5510
  • Fax:
Mailing address:
  • Phone: 608-469-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number99800-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: