Provider Demographics
NPI:1578980918
Name:ROBINSON, DIANE CAROL (RN, FNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:CAROL
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4285 STELLA ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-4771
Mailing Address - Country:US
Mailing Address - Phone:541-868-6014
Mailing Address - Fax:
Practice Address - Street 1:4285 STELLA ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-4771
Practice Address - Country:US
Practice Address - Phone:541-868-6014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR090003344163WC1500X, 163WW0000X
OR201809760NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR163WC1500XMedicaid