Provider Demographics
NPI:1457016750
Name:DIBIAGIO, CAROLINE KHOURY (DNP, AGAC-NP)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:KHOURY
Last Name:DIBIAGIO
Suffix:
Gender:F
Credentials:DNP, AGAC-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 27TH ST STE 306
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2669
Mailing Address - Country:US
Mailing Address - Phone:740-353-8661
Mailing Address - Fax:
Practice Address - Street 1:1711 27TH ST STE 306
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2669
Practice Address - Country:US
Practice Address - Phone:740-353-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029988363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care