Provider Demographics
NPI:1013136290
Name:FARMER, LERA DIANNA MARCELLE (RN,MN,CNNP,CPNP)
Entity type:Individual
Prefix:MRS
First Name:LERA DIANNA
Middle Name:MARCELLE
Last Name:FARMER
Suffix:
Gender:F
Credentials:RN,MN,CNNP,CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 STONE AVE
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2219
Mailing Address - Country:US
Mailing Address - Phone:256-362-1725
Mailing Address - Fax:
Practice Address - Street 1:722 STONE AVE
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2219
Practice Address - Country:US
Practice Address - Phone:256-362-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-036569363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891017656Medicaid