Individual
MISS KIMBERLY ANN DIEKOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
532 W STATE ST, BURLINGTON, WI 53105-1738
(262) 332-0039
Mailing address
532 W STATE ST, BURLINGTON, WI 53105-1738
(262) 332-0039
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
309693-31
WI
Other
Enumeration date
04/21/2011
Last updated
04/21/2011
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