Provider Demographics
NPI:1467514331
Name:REMBERT, DIANA CHERISE (CRNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:CHERISE
Last Name:REMBERT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:DEPT#0132
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0132
Mailing Address - Country:US
Mailing Address - Phone:256-728-8600
Mailing Address - Fax:256-728-8602
Practice Address - Street 1:4500 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:AL
Practice Address - Zip Code:35747-8303
Practice Address - Country:US
Practice Address - Phone:256-728-8600
Practice Address - Fax:256-728-8602
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1076318363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528301710Medicaid
ALS76764Medicare UPIN
AL528301710Medicaid