Provider Demographics
NPI:1386160125
Name:CHARLEBOIS, DIANA L (MSN-FNP)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:L
Last Name:CHARLEBOIS
Suffix:
Gender:F
Credentials:MSN-FNP
Other - Prefix:MISS
Other - First Name:DIANA
Other - Middle Name:L
Other - Last Name:POZNANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2817 NEW PINERY RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-9240
Mailing Address - Country:US
Mailing Address - Phone:608-745-4693
Mailing Address - Fax:608-745-6098
Practice Address - Street 1:2817 NEW PINERY ROAD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901
Practice Address - Country:US
Practice Address - Phone:608-745-4693
Practice Address - Fax:608-745-6098
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7884363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily