Provider Demographics
NPI:1598900201
Name:SUEOKA, DIANE M (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:M
Last Name:SUEOKA
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 505582
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5582
Mailing Address - Country:US
Mailing Address - Phone:314-993-7009
Mailing Address - Fax:314-993-1535
Practice Address - Street 1:10806 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7773
Practice Address - Country:US
Practice Address - Phone:314-993-7009
Practice Address - Fax:314-993-1535
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO137469363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420095597Medicaid