Provider Demographics
NPI:1629146063
Name:GERDEMAN, DIANE LYNN
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LYNN
Last Name:GERDEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:615-425-4200
Mailing Address - Fax:
Practice Address - Street 1:7059 ORCHARD CENTRE DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-7961
Practice Address - Country:US
Practice Address - Phone:567-297-4117
Practice Address - Fax:567-297-4118
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRX.16931-EX1363LF0000X
OHCOA.16931-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2355900OtherINDEPENDENT PROVIDER NURS