Individual provider Active NPI

Diane Lynn Vanderlin, RN MSN APNP C

  • Family Nurse Practitioner
  • Green Bay, WI
National Provider Identifier
1407807563
Registry record updated Dec 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1309-33 Issued in WI
Practice address
725 S Webster Ave Ste 303
Green Bay, WI 54301-3539
Phone
(920) 431-5650
Fax
(920) 433-7400
NPI assigned
May 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704152987 MI
Family Nurse Practitioner 363LF0000X 1309-33 WI Primary

Addresses

Primary practice location

725 S Webster Ave Ste 303
Green Bay, WI 54301-3539

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7210

Other practice location 1

1305 West American Drive
Neenah, WI 54956-2883
Phone (920) 725-9373

Other practice location 2

820 Arbutus Ave
Oconto, WI 54153-2004
Phone (920) 835-1100

Other practice location 3

2820 Roosevelt Rd
Marinette, WI 54143-3834
Phone (715) 735-5225

Other practice location 4

212 E B St
Iron Mountain, MI 49801-3411
Phone (906) 776-9040

Other identifiers 2

IdentifierTypeStateIssuer
43830900MedicaidWI
0240937OtherAMERICAN NURSES CREDENTIALING CENTER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070511000098 WI Practitioner - Nurse Practitioner 2961508726 Reassigns benefits to 2 organizations
I20221215001456 MI Practitioner - Nurse Practitioner 2961508726 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Registered Nurse

State licenses

LicenseStateTypeSpecialty
4704152987MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Oconto Hospital & Medical Center, Inc. CurrentSince Nov 10, 2021 Accepting new patients
Bellin Memorial Hospital Inc Current Accepting new patients
Bellin Memorial Hospital Inc Current Accepting new patients
Oconto Hospital & Medical Center Inc Current Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Nov 10, 2021 Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Nov 10, 2021 Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Nov 10, 2021 Accepting new patients

Locations

440 Woodward Ave
Iron Mountain, MI 49801
Phone (906) 776-9040

212 E B St
Iron Mountain, MI 49801
Phone (906) 774-2990

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

725 S Webster Ave
Ste 303
Green Bay, WI 54301
Phone (920) 431-5650

2820 Roosevelt Rd
Marinette, WI 54143
Phone (715) 330-6171

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670544000000",
    "number": "1407807563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7210",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 S WEBSTER AVE STE 303",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013539",
            "telephone_number": "920-431-5650",
            "fax_number": "920-433-7400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1305 West American Drive",
            "address_purpose": "LOCATION",
            "city": "Neenah",
            "state": "WI",
            "postal_code": "549562883",
            "country_code": "US",
            "telephone_number": "920-725-9373",
            "fax_number": "920-720-7392",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "820 Arbutus Ave",
            "address_purpose": "LOCATION",
            "city": "Oconto",
            "state": "WI",
            "postal_code": "541532004",
            "country_code": "US",
            "telephone_number": "920-835-1100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2820 Roosevelt Rd",
            "address_purpose": "LOCATION",
            "city": "Marinette",
            "state": "WI",
            "postal_code": "541433834",
            "country_code": "US",
            "telephone_number": "715-735-5225",
            "fax_number": "715-735-5388",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "212 E B St",
            "address_purpose": "LOCATION",
            "city": "Iron Mountain",
            "state": "MI",
            "postal_code": "498013411",
            "country_code": "US",
            "telephone_number": "906-776-9040",
            "fax_number": "906-774-5950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDERLIN",
        "first_name": "DIANE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "RN MSN APNP C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-13",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704152987",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "1309-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43830900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN NURSES CREDENTIALING CENTER",
            "identifier": "0240937",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.