Provider Demographics
NPI:1659802940
Name:CRUTCHER, DIANE L
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:L
Last Name:CRUTCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:L
Other - Last Name:ZAVALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:133 MYRTLE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-5427
Mailing Address - Country:US
Mailing Address - Phone:270-668-4186
Mailing Address - Fax:
Practice Address - Street 1:200 E CHESTNUT ST BLDG SUITE303
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-5552
Practice Address - Fax:502-629-3132
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily