Provider Demographics
NPI:1568257210
Name:DIVIRGILIO, DAWN DESIREE
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:DESIREE
Last Name:DIVIRGILIO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 E WILBUR AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-3343
Mailing Address - Country:US
Mailing Address - Phone:813-454-5392
Mailing Address - Fax:
Practice Address - Street 1:2400 E HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-3159
Practice Address - Country:US
Practice Address - Phone:414-229-4852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program