Healthcare Provider Details

I. General information

NPI: 1609964758
Provider Name (Legal Business Name): DIANNE JOYCE HOEKSTRA RN, CNS, APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9660 WICKER AVE
SAINT JOHN IN
46373-9487
US

IV. Provider business mailing address

3243 202ND ST
LYNWOOD IL
60411-8708
US

V. Phone/Fax

Practice location:
  • Phone: 219-365-1166
  • Fax:
Mailing address:
  • Phone: 708-474-7745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number70000134A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: