Provider Demographics
NPI:1083612519
Name:HORNEMAN, DIANE MARGARET (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARGARET
Last Name:HORNEMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-333-5736
Mailing Address - Fax:814-333-5819
Practice Address - Street 1:1034 GROVE ST
Practice Address - Street 2:DEPARTMENT OF COMPREHENSIVE PAIN CARE
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2945
Practice Address - Country:US
Practice Address - Phone:814-333-5736
Practice Address - Fax:814-333-5819
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP006472B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA066560TK8Medicare PIN
PAP79998Medicare UPIN