Provider Demographics
NPI:1598789919
Name:WEBB, DIANNE BLEVINS (FNP C)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:BLEVINS
Last Name:WEBB
Suffix:
Gender:F
Credentials:FNP C
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:
Other - Last Name:ROUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:201 FRANCIS MARION LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354
Mailing Address - Country:US
Mailing Address - Phone:276-781-7460
Mailing Address - Fax:276-781-7465
Practice Address - Street 1:201 FRANCIS MARION LN
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354
Practice Address - Country:US
Practice Address - Phone:276-781-7460
Practice Address - Fax:276-781-7465
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001048548163W00000X
VA0024048548363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
00V646C68Medicare ID - Type Unspecified