Healthcare Provider Details

I. General information

NPI: 1619130077
Provider Name (Legal Business Name): DIANA L SEEBOCK GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA LYNN SEEBOCK RN, MSN

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 KETTERING BLVD STE 100
MORAINE OH
45439-1948
US

IV. Provider business mailing address

3033 KETTERING BLVD STE 100
MORAINE OH
45439-1948
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-2133
  • Fax: 937-293-2161
Mailing address:
  • Phone: 937-293-2133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.06613-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: