Healthcare Provider Details

I. General information

NPI: 1003176173
Provider Name (Legal Business Name): DIANA L ERION FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E BROADWAY
COLUMBIA MO
65201-5844
US

IV. Provider business mailing address

1316 OLD HIGHWAY 63 S SUITE 102
COLUMBIA MO
65201-6092
US

V. Phone/Fax

Practice location:
  • Phone: 573-875-8838
  • Fax: 573-875-8589
Mailing address:
  • Phone: 573-875-8838
  • Fax: 575-875-8589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2012013585
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: