Basic Information
| Provider Information | |||||||||
| NPI: | 1760839062 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DISCH | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | APRN, AGPCNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 MINERAL POINT AVE | ||||||||
| Address2: | |||||||||
| City: | JANESVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535482940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087566871 | ||||||||
| FaxNumber: | 6087566836 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 MINERAL POINT AVE | ||||||||
| Address2: | |||||||||
| City: | JANESVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535482940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087566871 | ||||||||
| FaxNumber: | 6087566836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2016 | ||||||||
| LastUpdateDate: | 05/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WX0200X | 170394-30 | WI | N | Nursing Service Providers | Registered Nurse | Oncology | 363L00000X | 6854-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.