Diversified Health and Supportive Services LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

DIVERSIFIED HEALTH AND SUPPORTIVE SERVICES LLC

Practice address

11520 N Port Washington Rd Ste 208
Mequon, WI 53092-3432

Phone

(414) 651-5954

NPI assigned

Feb 21, 2022

Last updated

Feb 21, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shauna Pettis, MSN, APRN, AGPCNP-BCNPI 1902133143

Title

Owner/Subadministrator

Phone

(414) 748-7776

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shauna Pettis, ANP

  • Adult Health Nurse Practitioner
  • Brandywine, MD
  • NPI 1902133143
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645401600000",
    "number": "1225783913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2903 N 74TH ST APT 1",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532101000",
            "telephone_number": "414-651-5954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11520 N PORT WASHINGTON RD STE 208",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923432",
            "telephone_number": "414-651-5954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSIFIED HEALTH AND SUPPORTIVE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-21",
        "last_updated": "2022-02-21",
        "certification_date": "2022-02-20",
        "status": "A",
        "authorized_official_last_name": "PETTIS",
        "authorized_official_first_name": "SHAUNA",
        "authorized_official_title_or_position": "OWNER/SUBADMINISTRATOR",
        "authorized_official_telephone_number": "414-748-7776",
        "authorized_official_credential": "MSN, APRN, AGPCNP-BC"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David H Diamond, M.P.T.
• Kenneth Arthur Diamond, PH.D.
• Kathleen R Dionne, M.S.
• Philip W Diperna, N.P.
• Jessica Dippel
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• Bia Djelmami-Hani, RD, HWC
• Andreas Doermann, MD

• Home Health Agency in Mequon, WI
• Providers in Mequon, WI by specialty
• Home Health Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.