Provider Demographics
NPI:1710950068
Name:BORCHELT, DIANE M (APN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:BORCHELT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 1044
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:513-559-2580
Mailing Address - Fax:513-559-2596
Practice Address - Street 1:415 STRAIGHT ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1060
Practice Address - Country:US
Practice Address - Phone:513-559-2580
Practice Address - Fax:513-559-2596
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH331806163W00000X
OH09469363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH25041Medicare PIN
NV36787Medicare PIN
S60350Medicare UPIN