Provider Demographics
NPI:1932278744
Name:CRAINE, DIANE M (APRN-BC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:CRAINE
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4226 HARTLEY BRIDGE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-4115
Mailing Address - Country:US
Mailing Address - Phone:478-781-5065
Mailing Address - Fax:478-781-0012
Practice Address - Street 1:4226 HARTLEY BRIDGE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-4115
Practice Address - Country:US
Practice Address - Phone:478-781-5065
Practice Address - Fax:478-781-0012
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAR38817363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health