Provider Demographics
NPI:1386343507
Name:SLOCUM, DIANA L
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:SLOCUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:L
Other - Last Name:WISOCKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10950 N OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:MC CONNELL
Mailing Address - State:IL
Mailing Address - Zip Code:61050-9718
Mailing Address - Country:US
Mailing Address - Phone:815-656-0805
Mailing Address - Fax:
Practice Address - Street 1:3220 DEMING WAY STE 120
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-1498
Practice Address - Country:US
Practice Address - Phone:815-656-0805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041374904163WC0400X
WI256391163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management