Provider Demographics
NPI:1346506391
Name:SCHUNK, DIANE MARIE (ACNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:SCHUNK
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 STONE ST
Mailing Address - Street 2:STE 8
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3563
Mailing Address - Country:US
Mailing Address - Phone:810-989-0000
Mailing Address - Fax:810-989-5266
Practice Address - Street 1:1201 STONE ST
Practice Address - Street 2:STE 8
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3563
Practice Address - Country:US
Practice Address - Phone:810-989-0000
Practice Address - Fax:810-989-5266
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704186060363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care