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General NPI Number Information
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NPI Number | 1942210604
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Entity Type | Individual
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Provider Name | DIANE R. GRAYBILL KEHOE FNP
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Gender | Female
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 100 W 8TH ST
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City | MONROE
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State | WI
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Zip | 53566-1021
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Country | US
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Telephone | 608-324-1940
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Fax |
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Provider Business Mailing Address
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Address Line | 515 22ND AVENUE
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City | MONROE
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State | WI
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Zip | 53566-1569
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Country | US
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Telephone | 312-996-8009
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Fax | 312-996-7725
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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 | 209002308
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License Number State | IL
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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 | 209002308
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 6775
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License Number State | WI
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