Provider Demographics
NPI:1316218258
Name:CASTELLANOS, DIANE (ARNP -CNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:CASTELLANOS
Suffix:
Gender:F
Credentials:ARNP -CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E SHERIDAN AVE
Mailing Address - Street 2:ROOM 101
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-3200
Mailing Address - Country:US
Mailing Address - Phone:405-375-3008
Mailing Address - Fax:
Practice Address - Street 1:124 E SHERIDAN AVE
Practice Address - Street 2:ROOM 101
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-3200
Practice Address - Country:US
Practice Address - Phone:405-375-3008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK57633363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health