Provider Demographics
NPI:1396830873
Name:ESHLEMAN, DIANNA L (MS)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:L
Last Name:ESHLEMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:DIANNA
Other - Middle Name:L
Other - Last Name:BURKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1036
Mailing Address - Street 2:MALL 101 , SUITE A
Mailing Address - City:DEPOE BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97341
Mailing Address - Country:US
Mailing Address - Phone:541-765-3265
Mailing Address - Fax:541-765-3260
Practice Address - Street 1:MALL 101 SUITE A
Practice Address - Street 2:
Practice Address - City:DEPOE BAY
Practice Address - State:OR
Practice Address - Zip Code:97341
Practice Address - Country:US
Practice Address - Phone:541-765-3265
Practice Address - Fax:541-768-3260
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200150092NP207R00000X
OR200150110NP207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR262447Medicaid
OR262447Medicaid