Healthcare Provider Details

I. General information

NPI: 1801238084
Provider Name (Legal Business Name): DIANA MARIE KELLAR MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 YOUNGSTOWN KINGSVILLE RD SE
VIENNA OH
44473-9601
US

IV. Provider business mailing address

PO BOX 636988
CINCINNATI OH
45263-6988
US

V. Phone/Fax

Practice location:
  • Phone: 330-394-2305
  • Fax: 330-394-1405
Mailing address:
  • Phone: 888-940-2722
  • Fax: 513-632-8898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA14840NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: