Provider Demographics
NPI:1073902185
Name:KOEHL, DIANE (CNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:KOEHL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8859 BROOKSIDE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-7113
Mailing Address - Country:US
Mailing Address - Phone:513-779-6225
Mailing Address - Fax:513-779-6905
Practice Address - Street 1:8859 BROOKSIDE AVE STE 101
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-7113
Practice Address - Country:US
Practice Address - Phone:513-779-6225
Practice Address - Fax:513-779-6905
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007814364SF0001X
OH14967364SF0001X
OHAPRN.CNP.14967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health