Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 1721 | WI |
N | 363LG0600X | Nurse Practitioner - Gerontology | 1721 | WI |
NPI | 1053393769 |
---|---|
Provider Name | Diane L Sippel |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53705-3644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 13/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13106 | DEAN (01) | WI |
39080723697 | UNITY (01) | WI |
43939000 | (05) | WI |
500017150 | RAILROAD MEDICARE (01) | WI |
P27316 | (02) | |
WI01L7 | JOHN DEERE (01) | WI |