Provider Demographics
NPI:1689874406
Name:ERDMANN, DIANE ANNETTE (RN BSN IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ANNETTE
Last Name:ERDMANN
Suffix:
Gender:F
Credentials:RN BSN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6017 S 167TH CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-2393
Mailing Address - Country:US
Mailing Address - Phone:402-707-1696
Mailing Address - Fax:402-932-8581
Practice Address - Street 1:6017 S 167TH CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-2393
Practice Address - Country:US
Practice Address - Phone:402-707-1696
Practice Address - Fax:402-932-8581
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2013-04-15
Deactivation Date:2008-06-20
Deactivation Code:
Reactivation Date:2013-04-10
Provider Licenses
StateLicense IDTaxonomies
NE29841163WL0100X
NE19010535163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025817000Medicaid