Healthcare Provider Details

I. General information

NPI: 1396391629
Provider Name (Legal Business Name): DIANE MELROSE MSN, RN, AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

N99W16182 NORTHWAY
GERMANTOWN WI
53022-5026
US

V. Phone/Fax

Practice location:
  • Phone: 414-646-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number174823
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: