Healthcare Provider Details

I. General information

NPI: 1396830873
Provider Name (Legal Business Name): DIANNA L ESHLEMAN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANNA L BURKEY

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MALL 101 SUITE A
DEPOE BAY OR
97341
US

IV. Provider business mailing address

PO BOX 1036 MALL 101 , SUITE A
DEPOE BAY OR
97341
US

V. Phone/Fax

Practice location:
  • Phone: 541-765-3265
  • Fax: 541-768-3260
Mailing address:
  • Phone: 541-765-3265
  • Fax: 541-765-3260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number200150092NP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number200150110NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: