Provider Demographics
NPI:1346502408
Name:STADTMILLER, DIANE LORRAINE (PA)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LORRAINE
Last Name:STADTMILLER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:6112 COBBLESTONE DR
Mailing Address - Street 2:SUITE F8
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9001
Mailing Address - Country:US
Mailing Address - Phone:315-877-1116
Mailing Address - Fax:
Practice Address - Street 1:6112 COBBLESTONE DR
Practice Address - Street 2:SUITE F8
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9001
Practice Address - Country:US
Practice Address - Phone:315-877-1116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY03914363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant