Dykstra, Dezari M

Dykstra, Dezari M is an sole proprietor health care provider with primary practice located at 2514 S 102Nd St Ste 160 , West Allis WI 53227-2142. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Dykstra, Dezari M can be contacted via phone (434) 255-0300.

Contact Information

Primary practice address
2514 S 102Nd St Ste 160 West Allis WI 53227-2142
Phone: (434) 255-0300
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 148986-030 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 5964-33 Wisconsin

Profile Details

NPI number 1225105786
LBN Legal business name Dykstra, Dezari M
Credentials RN-MSN,FNP, APNP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 29th, 2006
Last updated Apr 18th, 2024 - about 8 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225105786 NPPES
Wisconsin MEDICAID 39877800

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