Doctor Name: | MARY DAHL |
NPI Number: | 1386034734 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | R.N. |
License Number: | 64020-030 |
Business Practice Address: | 352 S Brown Ave Peshtigo, WI - 541571523 |
Business Phone Number: | 9205911510 |
Business Fax Number: | |
Mailing Address: | 352 S Brown Ave, PESHTIGO |
State: | WI |
Postal Code: | 541571523 |
Phone Number: | 9205911510 |
Fax Number: | |
NPI Enumeration Date: | 01/23/2015 |
NPI Last Update Date: | 01/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WH0200X |
License Number: | 64020-030 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Home Health |
Taxonomy Definition: |