Provider Demographics
NPI:1376647065
Name:ESHLEMAN, DIANA JANE BERTELSEN (AUD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:JANE BERTELSEN
Last Name:ESHLEMAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:DIANA
Other - Middle Name:JANE
Other - Last Name:BERTELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:621 E CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2572
Mailing Address - Country:US
Mailing Address - Phone:704-799-7925
Mailing Address - Fax:844-315-2237
Practice Address - Street 1:621 E CENTER AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2572
Practice Address - Country:US
Practice Address - Phone:704-799-7925
Practice Address - Fax:844-315-2237
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10615231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1198481OtherWELLCARE
NC182R4OtherBCBS
NCQ44149AOtherMEDICARE