Provider Demographics
NPI:1053393769
Name:SIPPEL, DIANE L (NP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:SIPPEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 PRAIRIE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-2005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 PRAIRIE OAKS DR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-2005
Practice Address - Country:US
Practice Address - Phone:920-579-1063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1721363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13106OtherDEAN
WI39080723697OtherUNITY
WI43939000Medicaid
WI500017150OtherRAILROAD MEDICARE
WIWI01L7OtherJOHN DEERE
P27316Medicare UPIN
WI500017150OtherRAILROAD MEDICARE