Provider Demographics
NPI:1831179365
Name:ESSNER, DIANE L (CPNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:ESSNER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1839
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63702-1839
Mailing Address - Country:US
Mailing Address - Phone:573-335-2229
Mailing Address - Fax:573-339-8768
Practice Address - Street 1:1121 LINDEN ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-7708
Practice Address - Country:US
Practice Address - Phone:573-335-2229
Practice Address - Fax:573-339-8768
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO065400363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4259100007Medicaid
MO4259100007Medicaid