Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | ||
N | 225100000X | Physical Therapist | 2305 000587 | VA |
NPI | 1508847591 |
---|---|
Provider Name | Mrs. Dianne Ellen Epplein |
First Address | Virginia Beach, VA 23462-1116 |
Second Address | Virginia Beach, VA 23462-1116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007328 | ANTHEM BLUE CROSS GROUP (01) | |
11230312 | CAQH (01) | |
350034 | OPTIMA GROUP (01) | |
35062 | OPTIMA (01) | |
436752 | ANTHEM BLUE CROSS (01) | |
4980093 | (05) | VA |
4980093 | VIRGINIA PREMIER HEALTH P (01) | |
5275769 | AETNA GROUP (01) | |
5369690 | AETNA (01) | |
64 00313 | UNITED HEALTH CARE (01) | |
9116460 | MEDICAID (01) | VA |