Provider Demographics
NPI:1629170394
Name:SCRIBNER, DIANE C (PA-C)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:SCRIBNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 LAPEER
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1208
Mailing Address - Country:US
Mailing Address - Phone:989-759-6464
Mailing Address - Fax:989-399-8233
Practice Address - Street 1:239 N. STATE RD
Practice Address - Street 2:SUITE A,
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867
Practice Address - Country:US
Practice Address - Phone:989-729-4848
Practice Address - Fax:989-729-4849
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003092363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI175811OtherGREAT LAKES HEALTH PLAN OF MICHIGAN
MI54507OtherHEALTH PLAN OF MICHIGAN
381908328OtherTRICARE
MI381908328-433OtherCARE SOURCE OF MICHIGAN
MI080G310660OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI080G310660OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
381908328OtherTRICARE