Doctor Name: | CANDICE NICOLE DIENBERG |
NPI Number: | 1376968073 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CAPSW, SAC |
License Number: | 101YA0400X |
Business Practice Address: | 1015 Gammon Ln Madison, WI - 537192210 |
Business Phone Number: | 6084178144 |
Business Fax Number: | |
Mailing Address: | 202 S Park St, MADISON |
State: | WI |
Postal Code: | 53715 |
Phone Number: | 6084178144 |
Fax Number: | |
NPI Enumeration Date: | 03/04/2014 |
NPI Last Update Date: | 03/04/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 101YA0400X |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |