Provider Demographics
NPI:1518926443
Name:LEWTON, DIANE (NP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:LEWTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6920 POINTE INVERNESS WAY
Mailing Address - Street 2:STE 200
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-432-2297
Mailing Address - Fax:260-434-6420
Practice Address - Street 1:7916 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-432-2297
Practice Address - Fax:260-434-6420
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
500016270OtherRAILROAD
OH2463892Medicaid
OHLENP15741OtherMEDICAID-VANWERT
IN200321230Medicaid
OHLENP15742OtherMEDICAID-PAULDING
IN000000291182OtherANTHEM
IN260690RMedicare Oscar/Certification
INW59292Medicare UPIN
OH2463892Medicaid