Provider Demographics
NPI:1962663658
Name:KOESTER, DIANE KAY (RN, NP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:KAY
Last Name:KOESTER
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:KAY
Other - Last Name:KOESTER-WILKERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, NP
Mailing Address - Street 1:9834 GENESEE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1215
Mailing Address - Country:US
Mailing Address - Phone:858-625-4488
Mailing Address - Fax:858-625-7995
Practice Address - Street 1:9834 GENESEE AVE STE 300
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1215
Practice Address - Country:US
Practice Address - Phone:858-625-4488
Practice Address - Fax:858-625-7995
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 11678363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health