Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R135462 | MD |
N | 363L00000X | Nurse Practitioner | SP012115 | PA |
N | 363LA2200X | Nurse Practitioner - Adult Health | R135462 | MD |
NPI | 1023370921 |
---|---|
Provider Name | Mrs. Diane G Hearn |
First Address | Atlanta, GA 30368-7287 |
Second Address | Bethesda, MD 20817-1915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2012 |
Last Update Date | 16/06/2021 |