Provider Demographics
NPI:1376664375
Name:PROCTOR, DIANE L (RN, CNS)
Entity Type:Individual
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First Name:DIANE
Middle Name:L
Last Name:PROCTOR
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Gender:F
Credentials:RN, CNS
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Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:ML 5021
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3039
Mailing Address - Country:US
Mailing Address - Phone:513-636-2039
Mailing Address - Fax:866-851-6567
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 2003
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-4432
Practice Address - Fax:513-636-3952
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
OHCOA.06137-NS364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist