Provider Demographics
NPI:1891000576
Name:BINGHAM, DIANE L (NPC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3157
Mailing Address - Fax:812-242-3861
Practice Address - Street 1:567 N 5TH ST
Practice Address - Street 2:UAP/ISU STUDENT HEALTH CENTER
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47809-1903
Practice Address - Country:US
Practice Address - Phone:812-237-3883
Practice Address - Fax:812-237-8246
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000560A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400024837Medicare PIN