Healthcare Provider Details

I. General information

NPI: 1518133917
Provider Name (Legal Business Name): DIANA L. DUERRING FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 MACCORKLE AVE. SE.
CHARLESTON WV
25304
US

IV. Provider business mailing address

415 MORRIS STREET SUITE 304
CHARLESTON WV
25301
US

V. Phone/Fax

Practice location:
  • Phone: 304-925-4777
  • Fax: 304-925-4870
Mailing address:
  • Phone: 304-388-7784
  • Fax: 304-388-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number34740
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number34740
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: