Provider Demographics
NPI:1558355479
Name:HARRELL, DIANE L (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:HARRELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 CELANESE RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9406
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:803-327-5782
Practice Address - Street 1:2707 CELANESE RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-9406
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:803-327-5782
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC918363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC428960OtherRURAL MEDICARE
SCGP0641Medicaid
SCNP0699Medicaid
SCRHC127OtherRURAL MEDICAID
SC4754Medicare PIN
SCRHC127OtherRURAL MEDICAID