Provider Demographics
NPI:1912107780
Name:THOMAS, DIANE E (CRNA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:E
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:E
Other - Last Name:GRINDSTAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3045 S NATIONAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4268
Mailing Address - Country:US
Mailing Address - Phone:417-882-1900
Mailing Address - Fax:417-882-1966
Practice Address - Street 1:3045 S NATIONAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4268
Practice Address - Country:US
Practice Address - Phone:417-882-1900
Practice Address - Fax:417-882-1966
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO130338163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse