Provider Demographics
NPI:1396401444
Name:DIAL, DEANNA S (APRN)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:S
Last Name:DIAL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 HUNTER AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-2253
Mailing Address - Country:US
Mailing Address - Phone:573-475-9111
Mailing Address - Fax:573-457-7443
Practice Address - Street 1:808 HUNTER AVE STE 4
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-2253
Practice Address - Country:US
Practice Address - Phone:573-475-9111
Practice Address - Fax:573-457-7443
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2020035213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2020035213OtherCERTIFICATION