1396830873 NPI number — DIANNA L ESHLEMAN M.S.

Table of content: DIANNA L ESHLEMAN M.S. (NPI 1396830873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396830873 NPI number — DIANNA L ESHLEMAN M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESHLEMAN
Provider First Name:
DIANNA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURKEY
Provider Other First Name:
DIANNA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396830873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1036
Provider Second Line Business Mailing Address:
MALL 101 , SUITE A
Provider Business Mailing Address City Name:
DEPOE BAY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-765-3265
Provider Business Mailing Address Fax Number:
541-765-3260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MALL 101 SUITE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEPOE BAY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-765-3265
Provider Business Practice Location Address Fax Number:
541-768-3260
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  200150092NP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: 200150110NP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 262447 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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