Provider Demographics
NPI:1114035938
Name:CLYNE, DIANNA M (MD)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:M
Last Name:CLYNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 SOUTH 86TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9253
Mailing Address - Country:US
Mailing Address - Phone:402-476-7557
Mailing Address - Fax:402-769-9912
Practice Address - Street 1:4444 SOUTH 86TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9253
Practice Address - Country:US
Practice Address - Phone:402-476-7557
Practice Address - Fax:402-769-9912
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE183182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE345911000OtherMAGELLAN
NE35147OtherBCBS
NE35147OtherBCBS
F48570Medicare UPIN
276134Medicare PIN
NE345911000OtherMAGELLAN
NE35147OtherBCBS