Provider Demographics
NPI:1609969153
Name:GUTHRIE, DIANA (ARNP, PHD, CDE)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:ARNP, PHD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8533 E 32ND ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2611
Mailing Address - Country:US
Mailing Address - Phone:316-687-3100
Mailing Address - Fax:316-687-0286
Practice Address - Street 1:8533 E 32ND ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2611
Practice Address - Country:US
Practice Address - Phone:316-687-3100
Practice Address - Fax:316-687-0286
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44215363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSR31918Medicare UPIN
KS017680Medicare ID - Type Unspecified