Provider Demographics
NPI:1780041640
Name:ROBILLARD, DIANE (RN,NP,DMP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:ROBILLARD
Suffix:
Gender:F
Credentials:RN,NP,DMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 GRANITE WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-8969
Mailing Address - Country:US
Mailing Address - Phone:706-863-9954
Mailing Address - Fax:
Practice Address - Street 1:3521 GRANITE WAY
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-8969
Practice Address - Country:US
Practice Address - Phone:706-863-9954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-24
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN149275163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory