Provider Demographics
NPI:1780651125
Name:DUNSTON, DIANA HOLTZ (C-ANP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:HOLTZ
Last Name:DUNSTON
Suffix:
Gender:F
Credentials:C-ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9103 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2440
Mailing Address - Country:US
Mailing Address - Phone:225-927-1190
Mailing Address - Fax:225-927-0988
Practice Address - Street 1:9103 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2440
Practice Address - Country:US
Practice Address - Phone:225-927-1190
Practice Address - Fax:225-927-0988
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03329363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP32420Medicare UPIN
LA4B782Medicare ID - Type Unspecified
LA1561568Medicare ID - Type Unspecified