Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2012013585 | MO |
NPI | 1003176173 |
---|---|
Provider Name | Diana L Erion |
First Address | Columbia, MO 65201-6092 |
Second Address | Columbia, MO 65201-5844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2012 |
Last Update Date | 23/05/2012 |