Provider Demographics
NPI:1982784591
Name:MUCKENHIRN, DIANE P (RN, WHCNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:P
Last Name:MUCKENHIRN
Suffix:
Gender:F
Credentials:RN, WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19572 SKYVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-4316
Mailing Address - Country:US
Mailing Address - Phone:320-587-4907
Mailing Address - Fax:
Practice Address - Street 1:1965 FORD PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1923
Practice Address - Country:US
Practice Address - Phone:651-696-5509
Practice Address - Fax:651-698-2405
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0953856363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP16814OtherHEALTH PARTNERS PROV. ID
HP16814OtherHEALTH PARTNERS PROV. ID
MNMM0151097OtherMN DEA