Provider Demographics
NPI:1548234206
Name:MEEKS-SJOSTROM, DIANA J (FNP)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:J
Last Name:MEEKS-SJOSTROM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3363 PREAKNESS CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5553
Mailing Address - Country:US
Mailing Address - Phone:770-402-3973
Mailing Address - Fax:
Practice Address - Street 1:3363 PREAKNESS CT
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5553
Practice Address - Country:US
Practice Address - Phone:770-402-3973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN131825364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health