Healthcare Provider Details

I. General information

NPI: 1629055371
Provider Name (Legal Business Name): DINA M TWIGG CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21425 SPRING ST
UNION GROVE WI
53182-9707
US

IV. Provider business mailing address

5924 82ND PL
KENOSHA WI
53142-4756
US

V. Phone/Fax

Practice location:
  • Phone: 262-878-7001
  • Fax: 262-878-7024
Mailing address:
  • Phone: 262-652-0093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number120236-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: