Healthcare Provider Details

I. General information

NPI: 1952007684
Provider Name (Legal Business Name): DIANE FLORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 02/03/2023
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 OVERLOOK TER
MADISON WI
53705-2286
US

IV. Provider business mailing address

449 TODD ST
VERONA WI
53593-1031
US

V. Phone/Fax

Practice location:
  • Phone: 608-256-1901
  • Fax:
Mailing address:
  • Phone: 608-438-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number102680-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: