MR. DAVID EDWARD DETIENNE (NPI# 1174663363) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174663363 |
| Entity Type | Individual |
| Full Name | MR. DAVID EDWARD DETIENNE |
| Credential | RPH |
| Practice Address |
4404 State Road 70 Webster WI 54893-9251 |
| Mailing Address |
329 W Wisconsin Ave Grantsburg WI 54840-7818 |
| Practice Telephone | 7153498554 |
| Mailing Telephone | 7154633743 |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 11821-040 | WI | Pharmacy Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | WISCONS PHARMACIST LICENS | 11821-040 | 01 |
| Street Address |
4404 STATE ROAD 70 |
| City | WEBSTER |
| State | WI |
| Zip Code | 54893-9251 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346233350 | St. Croix Tribal Behavioral Health Clinic | Counselor | 4404 State Road 70, Webster, WI 54893-9251 | 2005-08-24 |
| 1124678818 | Muskadee Linda Montano | Social Worker | 4404 State Road 70, Webster, WI 54893-9251 | 2019-09-16 |
| 1194380543 | Deborah Ann Knutsen | Registered Nurse | 4404 State Road 70, Webster, WI 54893-9251 | 2019-05-01 |
| 1316415516 | Sandra Johnson | Registered Nurse | 4404 State Road 70, Webster, WI 54893-9251 | 2018-11-06 |
| 1801371190 | Dianna Kay Stumph | Registered Nurse | 4404 State Road 70, Webster, WI 54893-9251 | 2018-10-02 |
| 1184109597 | Lona Marie Noll | Licensed Practical Nurse | 4404 State Road 70, Webster, WI 54893-9251 | 2018-10-02 |
| 1598245045 | Kimberly M Stypula | Licensed Practical Nurse | 4404 State Road 70, Webster, WI 54893-9251 | 2018-08-15 |
| 1881171601 | Penny Lynn Bearheart | Counselor | 4404 State Road 70, Webster, WI 54893-9251 | 2018-07-24 |
| 1720573082 | Susan Evelyn Merchant | Dental Hygienist | 4404 State Road 70, Webster, WI 54893-9251 | 2018-06-28 |
| 1538652383 | Kayce R Rachner | Dental Hygienist | 4404 State Road 70, Webster, WI 54893-9251 | 2018-06-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427288711 | Jamie Ruiz | Licensed Practical Nurse | 27105 Lily Lake Rd, Webster, WI 54893 | 2009-07-21 |
| 1487875787 | St. Croix Tribal Council | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 4404 State Rd 70, Webster, WI 54893 | 2007-05-02 |
| 1851421903 | St Croix Falls Eye Associates | Optometrist | 7440 Main St West, Webster, WI 54893 | 2007-03-07 |
| 1396823324 | Benjamin Dale Blowers | Chiropractor | 7461 Main St West, Webster, WI 54893-0095 | 2006-11-01 |
| 1699195065 | Shannon Steiner | Licensed Practical Nurse | 8757 Perida Rd, Webster, WI 54893-7422 | 2014-04-23 |
| 1861662678 | Cary Mitchell Behm | Chiropractor | 26768 Lakeland Ave N, Webster, WI 54893-8106 | 2008-03-07 |
| 1174673511 | John W Ingalls | Family Medicine | 7456 Main St W, Webster, WI 54893-8205 | 2007-01-10 |
| 1265950240 | Erin M Vogland | Nurse Practitioner | 7456 Main St W, Webster, WI 54893-8205 | 2017-08-30 |
| 1255627972 | Leah B Jacobs | Nurse Practitioner | 7456 Main St W, Webster, WI 54893-8205 | 2011-06-21 |
| 1477843258 | Kathryn Ann Freese | Physical Therapy Assistant | 7456 Main St W, Webster, WI 54893-8205 | 2011-04-13 |
| Find all providers in zip 54893 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154971372 | Chelsea Nguyen | Pharmacist | 1310 Jasmine Ave, Webster, TX 77598-3402 | 2019-09-19 |
| 1154975027 | Emily Marie Hart | Pharmacist | 1221 Stockbridge Rd, Webster, NY 14580-9145 | 2019-07-30 |
| 1033779681 | Kevin Gress | Pharmacist | 251 W Medical Center Blvd Ste 100, Webster, TX 77598-4242 | 2019-06-17 |
| 1003327164 | Danielle Johnson | Pharmacist | 1236 Majestic Way, Webster, NY 14580-9538 | 2017-10-17 |
| 1609320183 | Jameela Fatima Khaja | Pharmacist | 434 Buoy Rd, Webster, TX 77598-2524 | 2016-08-12 |
| 1427431063 | Kristie Blanchette | Pharmacist | 1 Henry St, Webster, MA 01570-3525 | 2015-07-01 |
| 1699106203 | Daniel Safee | Pharmacist | 1139 Shoecraft Rd, Webster, NY 14580-8535 | 2013-12-06 |
| 1790023638 | Erin Jannetta | Pharmacist | 221 Basket Rd, Webster, NY 14580-9753 | 2013-01-28 |
| 1932470499 | Kerri Rottingen | Pharmacist | 60 Barrett Dr Ste 300, Webster, NY 14580-2987 | 2012-01-14 |
| 1649579442 | Geeta Acharya | Pharmacist | 60 Barrett Drive, A&j Pharmacy, Webster, NY 14580-2963 | 2011-03-18 |
| Find all providers in WEBSTER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.