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General NPI Number Information
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NPI Number | 1245610658
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Entity Type | Individual
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Provider Name | ALWIN A DIAZ N.P.
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Gender | Male
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Dates
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Enumeration Date | 06/02/2015
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 7201 GREEN BAY RD
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City | KENOSHA
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State | WI
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Zip | 53142-3532
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Country | US
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Telephone | 262-432-2352
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Fax | 262-697-5616
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Provider Business Mailing Address
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Address Line | 1675 N BARKER RD
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City | BROOKFIELD
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State | WI
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Zip | 53045-5200
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Country | US
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Telephone | 414-755-4898
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Fax | 262-754-0067
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 6367-33
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License Number State | WI
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