Provider Demographics
NPI:1306084439
Name:VISSER, VERA DIANE (RN)
Entity type:Individual
Prefix:MS
First Name:VERA
Middle Name:DIANE
Last Name:VISSER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:ELCHO
Mailing Address - State:WI
Mailing Address - Zip Code:54428-0134
Mailing Address - Country:US
Mailing Address - Phone:715-482-0788
Mailing Address - Fax:
Practice Address - Street 1:W10672 BLUEBIRD ST
Practice Address - Street 2:
Practice Address - City:ELCHO
Practice Address - State:WI
Practice Address - Zip Code:54428-9502
Practice Address - Country:US
Practice Address - Phone:715-482-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2014-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI159539163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse