MEDICARE: DANACARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1326813825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANACARE LLC

Provider Business Mailing Address
First Line	:	6530 SHERIDAN RD STE 7
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53143-5063
Country	:	US
Telephone Number	:	262-455-7047
Fax Number	:	262-218-4442

Provider Business Practice Location Address
First Line	:	6530 SHERIDAN RD STE 7
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53143-5063
Country	:	US
Telephone Number	:	262-455-7047
Fax Number	:	262-218-4442

Authorized Official
Title or Position	:	OWNER
Name	:	DANA MARIE MEHRING
Credential	:	NP
Telephone Number	:	262-331-4389

Provider Enumeration Date	:	11/15/2023
Last Update Date	:	03/18/2024

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