Individual
VIVIAN L DEHAHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
33300 CAYUGA WAY, EAST TROY, WI 53120-9633
(262) 210-0563
Mailing address
33300 CAYUGA WAY, EAST TROY, WI 53120-9633
(262) 210-0563
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
88058-030
WI
363L00000X
Nurse Practitioner
Primary
1451-033
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43893400
—
WI
Enumeration date
09/15/2005
Last updated
11/30/2021
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