Provider Demographics
NPI:1265481501
Name:CASE, DIANA (PA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:CASE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 HIGHWAY 71 W
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-4105
Mailing Address - Country:US
Mailing Address - Phone:515-445-4800
Mailing Address - Fax:512-308-9649
Practice Address - Street 1:301 HIGHWAY 71 W
Practice Address - Street 2:SUITE 111
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4105
Practice Address - Country:US
Practice Address - Phone:515-445-4800
Practice Address - Fax:512-308-9649
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA01874363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical