Individual
MRS. DEZARI M DYKSTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN-MSN,FNP, APNP
Contact information
Practice address
2514 S 102ND ST STE 160, WEST ALLIS, WI 53227-2142
(434) 255-0300
Mailing address
PO BOX 639295 DEPT 93394, CINCINNATI, OH 45263-9295
(248) 266-4200
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
148986-030
WI
363LF0000X
Family Nurse Practitioner
Primary
5964-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39877800
—
WI
Enumeration date
11/29/2006
Last updated
04/18/2024
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