Individual
MRS. SHANNA JAY DIERKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
3925 N GATEWAY DR, APPLETON, WI 54913-7863
(920) 702-6371
Mailing address
3 NEENAH CTR, NEENAH, WI 54956-3070
(920) 702-6371
(920) 358-1173
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041404031
IL
163W00000X
Registered Nurse
2015032867
MO
363LF0000X
Family Nurse Practitioner
Primary
15817
WI
363LF0000X
Family Nurse Practitioner
209-014331
IL
363LF0000X
Family Nurse Practitioner
A143402
IA
Other
Enumeration date
01/25/2016
Last updated
02/19/2025
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