Provider Demographics
NPI:1013115757
Name:MAGGINETTI, DIANNA KAY (ARNP)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:KAY
Last Name:MAGGINETTI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DIANNA
Other - Middle Name:KAY
Other - Last Name:TREOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:905 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-4407
Mailing Address - Country:US
Mailing Address - Phone:319-874-3000
Mailing Address - Fax:
Practice Address - Street 1:905 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-4407
Practice Address - Country:US
Practice Address - Phone:319-874-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60585215363LP0808X
IAG156946363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01540043OtherRR PTAN
WA1013115757Medicaid
WAG8944978, G8944979Medicare PIN