Provider Demographics
NPI:1396289534
Name:DINE, DAVID E (CNP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:DINE
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:885 S SAWBURG AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-5926
Mailing Address - Country:US
Mailing Address - Phone:330-823-1112
Mailing Address - Fax:330-823-1139
Practice Address - Street 1:885 S SAWBURG AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-5926
Practice Address - Country:US
Practice Address - Phone:330-823-1112
Practice Address - Fax:330-823-1139
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00005218363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLE-00005218OtherCNP
OHAG1016083OtherAANP CERTIFICATION