Provider Demographics
NPI:1114029451
Name:WEMHOFF, DIANA (APRN, BC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:WEMHOFF
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 UNION AVE STE D
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-9469
Mailing Address - Country:US
Mailing Address - Phone:660-263-4770
Mailing Address - Fax:660-263-2228
Practice Address - Street 1:1501 UNION AVE STE D
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-9469
Practice Address - Country:US
Practice Address - Phone:660-263-4770
Practice Address - Fax:660-263-2228
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO021440122363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1114029451Medicaid
MO1114029451Medicaid
MOR03273Medicare UPIN