Healthcare Provider Details

I. General information

NPI: 1003596503
Provider Name (Legal Business Name): CORENCIA DIANN & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 S WHITNALL EDGE RD
FRANKLIN WI
53132-1217
US

IV. Provider business mailing address

6535 S WHITNALL EDGE RD
FRANKLIN WI
53132-1217
US

V. Phone/Fax

Practice location:
  • Phone: 920-205-0683
  • Fax:
Mailing address:
  • Phone: 920-205-0683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: TAMMIE M FOWLER
Title or Position: CEO/OWNER
Credential:
Phone: 920-205-0683