Provider Demographics
NPI:1003883224
Name:HERRON, DIANE M (BS MS BSN MSN CNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:HERRON
Suffix:
Gender:F
Credentials:BS MS BSN MSN CNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:20525 CENTER RIDGE ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116
Mailing Address - Country:US
Mailing Address - Phone:440-895-5021
Mailing Address - Fax:440-895-5050
Practice Address - Street 1:25200 CENTER RIDGE ROAD
Practice Address - Street 2:SUITE 1100
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145
Practice Address - Country:US
Practice Address - Phone:440-333-3332
Practice Address - Fax:440-331-3894
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHNP05806363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000356906OtherANTHEM
A72356OtherSUMMACARE APEX
341783789116OtherCARESOURCE
0113106OtherUNITED HEALTHCARE
OH2431336Medicaid
0653707OtherAETNA
OH2431336Medicaid
P98417Medicare UPIN