Healthcare Provider Details

I. General information

NPI: 1750212452
Provider Name (Legal Business Name): KATHERINE DEDERING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S WASHINGTON ST
COMBINED LOCKS WI
54113-1049
US

IV. Provider business mailing address

231 W PROSPECT AVE
APPLETON WI
54911-6013
US

V. Phone/Fax

Practice location:
  • Phone: 920-716-6316
  • Fax:
Mailing address:
  • Phone: 920-716-6316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number193739-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: