Provider Demographics
NPI:1902511850
Name:DAHL, ANNE KATHERINE (BSN, RN, IBCLC, CPST)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:KATHERINE
Last Name:DAHL
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC, CPST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 CRUSADE LN
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-5400
Mailing Address - Country:US
Mailing Address - Phone:920-615-0506
Mailing Address - Fax:
Practice Address - Street 1:1300 W MAIN AVE
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9366
Practice Address - Country:US
Practice Address - Phone:920-336-6594
Practice Address - Fax:920-336-7132
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI150640-30163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant