DIANE MATILDA PIVONKA MS RN APNP NPI 1457583163

NPI Information

NPI: 1457583163
Provider Name: DIANE MATILDA PIVONKA, MS, RN, APNP
Classification: Clinical Nurse Specialist - 364SP0809X
Entity Type: Individual

Specialization: Psychiatric/Mental Health, Adult

Address:
1499 6TH ST
GREEN BAY, WI
ZIP 54304
Phone: (920) 497-6161
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Diane Matilda Pivonka, MS, RN, APNP is a psychiatric/mental health and adult clinical nurse specialist in Green Bay, WI. Diane Matilda Pivonka, MS, RN, APNP NPI is 1457583163. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1499 6TH ST
GREEN BAY, WI
ZIP 54304-252
Phone: (920) 497-6161
Fax: (920) 498-0476

The enumeration date for this NPI number is 8/13/2009 and was last updated on 2/12/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	364SP0809X	Clinical Nurse Specialist	Psychiatric/Mental Health, Adult	1822-033	WISCONSIN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	41252600	MEDICAID	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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