Provider Demographics
NPI:1760094577
Name:HIESTAND, DIANA MICHELLE (DNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MICHELLE
Last Name:HIESTAND
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:MICHELLE
Other - Last Name:SCHLAGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5911 HOLMES ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-3031
Mailing Address - Country:US
Mailing Address - Phone:816-591-1279
Mailing Address - Fax:
Practice Address - Street 1:315 W 75TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-5738
Practice Address - Country:US
Practice Address - Phone:816-591-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020023491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily