Provider Demographics
NPI:1639675374
Name:ROEL, DIANE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ROEL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 THORNTON ST
Mailing Address - Street 2:
Mailing Address - City:COTULLA
Mailing Address - State:TX
Mailing Address - Zip Code:78014
Mailing Address - Country:US
Mailing Address - Phone:830-879-3540
Mailing Address - Fax:
Practice Address - Street 1:606 W LEONA ST
Practice Address - Street 2:
Practice Address - City:DILLEY
Practice Address - State:TX
Practice Address - Zip Code:78017-3705
Practice Address - Country:US
Practice Address - Phone:830-965-1797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily