Healthcare Provider Details

I. General information

NPI: 1215177175
Provider Name (Legal Business Name): DIANE ELIZABETH DAUGHARTY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WINCHESTER RD
NEENAH WI
54956-9317
US

IV. Provider business mailing address

2100 WINCHESTER RD
NEENAH WI
54956-9317
US

V. Phone/Fax

Practice location:
  • Phone: 920-721-5632
  • Fax: 920-721-5137
Mailing address:
  • Phone: 920-721-5632
  • Fax: 920-721-5137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number1269-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: