Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 6175 | WI |
NPI | 1013305200 |
---|---|
Provider Name | Kristina L Diehn |
First Address | Franklin, WI 53132-7209 |
Second Address | Franklin, WI 53132-7209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2014 |
Last Update Date | 26/06/2015 |