Provider Demographics
NPI:1427293067
Name:WEINREICH, DIANE MARIE (APRN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARIE
Last Name:WEINREICH
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 JEFFERSON
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-2106
Mailing Address - Country:US
Mailing Address - Phone:660-831-1175
Mailing Address - Fax:660-831-3364
Practice Address - Street 1:2303 S HIGHWAY 65 STE A
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3735
Practice Address - Country:US
Practice Address - Phone:660-831-1175
Practice Address - Fax:660-831-3364
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO142617363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2008009796OtherAMERICAN NURSES CREDENTIALING CENTER
MO420012554Medicaid