Provider Demographics
NPI:1881860716
Name:HANCOCK, DIANE AVERY (NP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:AVERY
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 BROAD ROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23249
Mailing Address - Country:US
Mailing Address - Phone:804-675-5553
Mailing Address - Fax:804-675-5778
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249
Practice Address - Country:US
Practice Address - Phone:804-675-5553
Practice Address - Fax:804-675-5778
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5003970363LG0600X
VA0024169724363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology