Provider Demographics
NPI:1467652206
Name:SMITH, DIANE K (MSN, APRN-BC, GNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, APRN-BC, GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 10TH ST SE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2414
Mailing Address - Country:US
Mailing Address - Phone:319-558-4903
Mailing Address - Fax:319-369-8402
Practice Address - Street 1:202 10TH ST SE
Practice Address - Street 2:SUITE 111
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2414
Practice Address - Country:US
Practice Address - Phone:319-558-4903
Practice Address - Fax:319-369-8402
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAJ060120363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology