Provider Demographics
NPI:1316139413
Name:SMITH, DIANE HEINDL (APRN)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:HEINDL
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:MARGARET
Other - Last Name:HEINDL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN APN
Mailing Address - Street 1:10479 DOUBLE R BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8905
Mailing Address - Country:US
Mailing Address - Phone:775-850-8600
Mailing Address - Fax:775-850-8665
Practice Address - Street 1:10479 DOUBLE R BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8905
Practice Address - Country:US
Practice Address - Phone:775-850-8600
Practice Address - Fax:775-850-8665
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000730207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology