Provider Demographics
NPI:1538128509
Name:TAO, DIANNE LYNN (WHNP)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:LYNN
Last Name:TAO
Suffix:
Gender:F
Credentials:WHNP
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 5545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5545
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:
Practice Address - Street 1:938 MEZZANINE DR STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8641
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-838-6302
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000014A363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000321052OtherANTHEM PROVIDER NUMBER
IN200096800Medicaid
IN9397703OtherPHCS PID NUMBER
IN815500K9Medicare PIN
IN8154660YMedicare PIN
IN200096800Medicaid
IN9397703OtherPHCS PID NUMBER
IN000000321052OtherANTHEM PROVIDER NUMBER