Provider Demographics
NPI:1760481113
Name:ENZWEILER, DIANE (ARNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ENZWEILER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 MERCY HEALTH BLVD
Mailing Address - Street 2:125
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-1105
Mailing Address - Country:US
Mailing Address - Phone:513-215-9200
Mailing Address - Fax:513-215-9259
Practice Address - Street 1:3301 MERCY HEALTH BLVD
Practice Address - Street 2:125
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1105
Practice Address - Country:US
Practice Address - Phone:513-215-9200
Practice Address - Fax:513-215-9259
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3001921363L00000X
OHAPRN.CNP.04623363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2993775Medicaid
KYP00920131OtherRAILROAD MEDICARE
KY78192101Medicaid
KYP00920131OtherRAILROAD MEDICARE
KYP400035837Medicare PIN
KYR37587Medicare UPIN