Provider Demographics
NPI:1558668632
Name:ROBERTS, DIANE ELIZABETH (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ELIZABETH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:ELIZABETH
Other - Last Name:BENGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:58 DAISY DR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-6440
Mailing Address - Country:US
Mailing Address - Phone:606-312-3801
Mailing Address - Fax:
Practice Address - Street 1:58 DAISY DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-6440
Practice Address - Country:US
Practice Address - Phone:606-312-3801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1080250163W00000X
KY086603367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse