Healthcare Provider Details

I. General information

NPI: 1134667538
Provider Name (Legal Business Name): UMECCA DIANE COWART CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 COLLINGWOOD BLVD
TOLEDO OH
43620-1152
US

IV. Provider business mailing address

9065 NEWPORT WAY
LIVONIA MI
48150-4171
US

V. Phone/Fax

Practice location:
  • Phone: 419-442-7701
  • Fax: 419-225-8878
Mailing address:
  • Phone: 313-207-5134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1020807
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.022132
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024912
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704277432
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: