Provider Demographics
NPI:1295703270
Name:POWE-CRONIN, DIANE (CRNA)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:POWE-CRONIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 GANN XING SW
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-4473
Mailing Address - Country:US
Mailing Address - Phone:229-269-2751
Mailing Address - Fax:
Practice Address - Street 1:4619 GANN XING SW
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-4473
Practice Address - Country:US
Practice Address - Phone:229-269-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2058367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC37370OtherAANA