Provider Demographics
NPI:1043367006
Name:HOLLISTER, DIANNE J (CNP)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:J
Last Name:HOLLISTER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:J
Other - Last Name:CLAFFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3495 PIEDMONT ROAD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-9775
Mailing Address - Country:US
Mailing Address - Phone:404-364-7000
Mailing Address - Fax:404-364-4732
Practice Address - Street 1:2525 CUMBERLAND PARKWAY
Practice Address - Street 2:DEPARTMENT OF DIABETES CARE
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339
Practice Address - Country:US
Practice Address - Phone:770-431-4235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN139277363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
50BBHTPMedicare ID - Type Unspecified
Q25694Medicare UPIN