Provider Demographics
NPI:1851346894
Name:CASEY, DIANE DENISE (APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:DENISE
Last Name:CASEY
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
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Mailing Address - Street 1:12302 BAYSHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:GRABILL
Mailing Address - State:IN
Mailing Address - Zip Code:46741-9609
Mailing Address - Country:US
Mailing Address - Phone:260-373-4331
Mailing Address - Fax:260-373-4323
Practice Address - Street 1:2200 RANDALLIA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4638
Practice Address - Country:US
Practice Address - Phone:260-373-4331
Practice Address - Fax:260-373-4323
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71000525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily