Provider Demographics
NPI:1184809139
Name:WILLGING, DIANE JANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:JANE
Last Name:WILLGING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:JANE
Other - Last Name:WILLGING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RNC WHNP
Mailing Address - Street 1:1323 COON RAPIDS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5362
Mailing Address - Country:US
Mailing Address - Phone:763-755-5300
Mailing Address - Fax:763-755-5301
Practice Address - Street 1:1323 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5362
Practice Address - Country:US
Practice Address - Phone:763-755-5300
Practice Address - Fax:763-755-5301
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNWIL-0428-3281363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP28934Medicare UPIN