MEDICARE: DINA M TWIGG CNP

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	363LA2200X	Adult Health Nurse Practitioner	120236-030	WI

General Provider Information

NPI Number	:	1629055371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINA M TWIGG CNP

Provider Business Mailing Address
First Line	:	5924 82ND PL
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53142-4756
Country	:	US
Telephone Number	:	262-652-0093
Fax Number	:

Provider Business Practice Location Address
First Line	:	21425 SPRING ST
Second Line	:
City	:	UNION GROVE
State	:	WI
Zip	:	53182-9707
Country	:	US
Telephone Number	:	262-878-7001
Fax Number	:	262-878-7024

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	05/22/2014

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