Provider Demographics
NPI:1235686379
Name:OPADERE, DIANAROSE
Entity Type:Individual
Prefix:
First Name:DIANAROSE
Middle Name:
Last Name:OPADERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANAROSE
Other - Middle Name:
Other - Last Name:ONYANGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 SCHENCK PKWY
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3499
Mailing Address - Country:US
Mailing Address - Phone:828-681-1527
Mailing Address - Fax:
Practice Address - Street 1:509 BILTMORE AVE
Practice Address - Street 2:EDWARD HOORNSTRA
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-5528
Practice Address - Country:US
Practice Address - Phone:828-213-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA218218367500000X
NC273186367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered