Provider Demographics
NPI:1417131038
Name:DEWBRE, DIANE (GNP-BC)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:DEWBRE
Suffix:
Gender:F
Credentials:GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-4220
Mailing Address - Country:US
Mailing Address - Phone:405-527-4704
Mailing Address - Fax:405-427-5976
Practice Address - Street 1:128 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-4220
Practice Address - Country:US
Practice Address - Phone:405-527-4704
Practice Address - Fax:405-427-5976
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX547215363LG0600X
OK49456363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20053303AMedicaid