Provider Demographics
NPI:1285695999
Name:ERNST, DIANE JEAN (ARNP)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:JEAN
Last Name:ERNST
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:JEAN
Other - Last Name:ERNST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2325
Mailing Address - Country:US
Mailing Address - Phone:563-382-9671
Mailing Address - Fax:563-382-4143
Practice Address - Street 1:901 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2325
Practice Address - Country:US
Practice Address - Phone:563-382-9671
Practice Address - Fax:563-382-4143
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC044854363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0434761Medicaid
IAIA0108OtherJOHN DEERE HEALTHCARE