Provider Demographics
NPI:1144208711
Name:DIANA, LORRAINE R (NP)
Entity type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:R
Last Name:DIANA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:R
Other - Last Name:MERRANKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40900 MERCHANTS LN
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-3795
Mailing Address - Country:US
Mailing Address - Phone:301-997-1315
Mailing Address - Fax:301-997-1110
Practice Address - Street 1:40900 MERCHANTS LN
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3795
Practice Address - Country:US
Practice Address - Phone:301-997-1315
Practice Address - Fax:301-997-1110
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR069788363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN