MEDICARE: DIANA L SEEBOCK GNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	COA.06613-NP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CS1431500185	OTHER	OH	CARE SOURCE
2	000000877722	OTHER	OH	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619130077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA L SEEBOCK GNP

Provider Business Mailing Address
First Line	:	3033 KETTERING BLVD STE 100
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1948
Country	:	US
Telephone Number	:	937-293-2133
Fax Number	:

Provider Business Practice Location Address
First Line	:	3033 KETTERING BLVD STE 100
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1948
Country	:	US
Telephone Number	:	937-293-2133
Fax Number	:	937-293-2161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	02/12/2016

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