Provider Demographics
NPI:1104313436
Name:DIEMER, DIANA CATHERINE (FNP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:CATHERINE
Last Name:DIEMER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 W GREEN ST STE 304
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1725
Mailing Address - Country:US
Mailing Address - Phone:269-948-8057
Mailing Address - Fax:269-948-8964
Practice Address - Street 1:1005 W GREEN ST STE 304
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1725
Practice Address - Country:US
Practice Address - Phone:269-948-8057
Practice Address - Fax:269-948-8964
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704272488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine