=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316218258
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANE CASTELLANOS ARNP -CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2012
-----------------------------------------------------
Last Update Date | 01/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 124 E SHERIDAN AVE ROOM 101
-----------------------------------------------------
City | KINGFISHER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73750-3200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-375-3008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 124 E SHERIDAN AVE ROOM 101
-----------------------------------------------------
City | KINGFISHER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73750-3200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-375-3008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | 57633
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------