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General NPI Number Information
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NPI Number | 1205167095
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Entity Type | Organization
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Legal Business Name | DIANE BORCHELT, NP
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Dates
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Enumeration Date | 01/19/2010
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Last Update Date | 01/19/2010
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Provider Practice Location Address
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Address Line | 17 EAGLE CT
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City | AMELIA
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State | OH
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Zip | 45102-2162
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Country | US
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Telephone | 513-753-8112
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Fax |
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Provider Business Mailing Address
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Address Line | 17 EAGLE CT
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City | AMELIA
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State | OH
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Zip | 45102-2162
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Country | US
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Telephone | 513-753-8112
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIANE MARIE BORCHELT
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Credential | MS, NP
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Telephone | 513-753-8112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 09469
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License Number State | OH
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