Provider Demographics
NPI:1295010494
Name:WOMER, DIANNA
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:WOMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANNA
Other - Middle Name:
Other - Last Name:STATLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:150 W MAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9229
Mailing Address - Country:US
Mailing Address - Phone:614-685-2058
Mailing Address - Fax:614-685-9427
Practice Address - Street 1:150 W MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-9229
Practice Address - Country:US
Practice Address - Phone:614-685-2058
Practice Address - Fax:614-685-9427
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP12817363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0055677Medicaid
OH0055677Medicaid