Provider Demographics
NPI:1790735694
Name:CARRO, DIANA L (ARNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:CARRO
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 1:3122 N CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4014
Mailing Address - Country:US
Mailing Address - Phone:316-684-5257
Mailing Address - Fax:316-684-9369
Practice Address - Street 1:3122 N CYPRESS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4013
Practice Address - Country:US
Practice Address - Phone:316-684-5257
Practice Address - Fax:316-684-9369
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS161198OtherBLUE CROSS BLUE SHIELD OF