Diversified Health and Supportive Services LLC

NPI #1225783913 in Mequon, Wisconsin

Provider Information

NPI Number: 1225783913
Entity Type: Organization
Organization Name: Diversified Health and Supportive Services LLC
Primary Specialty: Home Health
Enumeration Date: Feb 21, 2022
Last Updated: Feb 21, 2022

Practice Location

Address: 11520 N PORT WASHINGTON RD STE 208
City: Mequon
State: Wisconsin
ZIP Code: 53092-3432
Phone: (414) 651-5954

Authorized Official

Name: SHAUNA PETTIS, MSN, APRN, AGPCNP-BC
Title: OWNER/SUBADMINISTRATOR
Phone: (414) 748-7776

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Home Health	251E00000X	Primary

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