Provider Demographics
NPI:1306859608
Name:VALENTINE, DIANE T (FNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:T
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613
Mailing Address - Country:US
Mailing Address - Phone:417-637-5133
Mailing Address - Fax:417-637-5124
Practice Address - Street 1:105 N GRAND ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GREENFIELD
Practice Address - State:MO
Practice Address - Zip Code:65661-8198
Practice Address - Country:US
Practice Address - Phone:417-637-5133
Practice Address - Fax:417-637-5124
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN080891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR77586Medicare UPIN