Healthcare Provider Details

I. General information

NPI: 1619168275
Provider Name (Legal Business Name): DIANA LOUISE SHAGER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 13TH ST
MONROE WI
53566-2243
US

IV. Provider business mailing address

7601 W COUNTY ROAD M
GRATIOT WI
53541-9731
US

V. Phone/Fax

Practice location:
  • Phone: 608-325-2757
  • Fax:
Mailing address:
  • Phone: 608-968-3466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: