Provider Demographics
NPI:1700694627
Name:DESMIDT, NADINE MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:MARIE
Last Name:DESMIDT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N112W16076 MEQUON RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-3333
Mailing Address - Country:US
Mailing Address - Phone:262-293-9098
Mailing Address - Fax:
Practice Address - Street 1:N112W16076 MEQUON RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3333
Practice Address - Country:US
Practice Address - Phone:262-293-9098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI201034163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse