Provider Demographics
NPI:1538127733
Name:HUCK, DIANE MARIE (RN, GNP)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:HUCK
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Gender:F
Credentials:RN, GNP
Other - Prefix:
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Mailing Address - Street 1:204 N KEENE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8102
Mailing Address - Country:US
Mailing Address - Phone:573-442-0320
Mailing Address - Fax:573-442-0421
Practice Address - Street 1:204 N KEENE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8102
Practice Address - Country:US
Practice Address - Phone:573-442-0320
Practice Address - Fax:573-442-0421
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO123075363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology