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General NPI Number Information
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NPI Number | 1558728337
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Entity Type | Individual
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Provider Name | SHANNA JAY DIERKER FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 3925 N GATEWAY DR
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City | APPLETON
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State | WI
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Zip | 54913-7863
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Country | US
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Telephone | 920-702-6371
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Fax |
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Provider Business Mailing Address
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Address Line | 3 NEENAH CTR
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City | NEENAH
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State | WI
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Zip | 54956-3070
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Country | US
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Telephone | 920-702-6371
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Fax | 920-358-1173
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A143402
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209-014331
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 15817
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2015032867
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License Number State | MO
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Taxonomy #5
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041404031
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License Number State | IL
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