Organization
DIVERSIFIED HEALTH AND SUPPORTIVE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUNA PETTIS MSN, APRN, AGPCNP-BC (OWNER/SUBADMINISTRATOR)
(414) 748-7776
Entity
Organization
Contact information
Practice address
11520 N PORT WASHINGTON RD STE 208, MEQUON, WI 53092-3432
(414) 651-5954
Mailing address
2903 N 74TH ST APT 1, MILWAUKEE, WI 53210-1000
(414) 651-5954
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
02/21/2022
Last updated
02/21/2022
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