Provider Demographics
NPI:1093934580
Name:COMPO MILOW, DIANE LYNN
Entity Type:Individual
Prefix:PROF
First Name:DIANE
Middle Name:LYNN
Last Name:COMPO MILOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:LYNN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:4701 TUXEDO BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUND
Mailing Address - State:MN
Mailing Address - Zip Code:55364-9169
Mailing Address - Country:US
Mailing Address - Phone:952-472-0430
Mailing Address - Fax:
Practice Address - Street 1:COLLEGE OF ST. CATHERINE
Practice Address - Street 2:2004 RANDOLPH AVE
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55454
Practice Address - Country:US
Practice Address - Phone:651-690-6714
Practice Address - Fax:651-690-6188
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 111945-3367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife