Provider Demographics
NPI:1245517663
Name:HORNER, DIANE KOSTREY (NP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:KOSTREY
Last Name:HORNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WEST 10TH STREET
Mailing Address - Street 2:DUNLAP 4TH FLOOR
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202
Mailing Address - Country:US
Mailing Address - Phone:317-278-1022
Mailing Address - Fax:317-656-4061
Practice Address - Street 1:1001 W 10TH ST
Practice Address - Street 2:DUNLAP 4TH FLOOR
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2859
Practice Address - Country:US
Practice Address - Phone:317-278-1022
Practice Address - Fax:317-656-4061
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28106710A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily