Provider Demographics
NPI:1568449452
Name:WEGNER, DIANA (NP-C)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:WEGNER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:GARZA-YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:8841 MARAUDER DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4187
Mailing Address - Country:US
Mailing Address - Phone:281-974-8530
Mailing Address - Fax:
Practice Address - Street 1:7600 BEECHNUT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-4302
Practice Address - Country:US
Practice Address - Phone:713-456-8188
Practice Address - Fax:713-448-8045
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX537308363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81N561Medicare ID - Type Unspecified