Provider Demographics
NPI:1518942119
Name:VARNADORE, DIANE STEGALL (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:STEGALL
Last Name:VARNADORE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:
Other - Last Name:VARNADORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:120 CHARLES D ROLLINS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2882
Mailing Address - Country:US
Mailing Address - Phone:252-430-8111
Mailing Address - Fax:252-430-1804
Practice Address - Street 1:120 CHARLES D ROLLINS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2882
Practice Address - Country:US
Practice Address - Phone:252-430-8111
Practice Address - Fax:252-430-1804
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900473207RG0100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592452Medicare ID - Type Unspecified
NCQ53504Medicare UPIN