Provider Demographics
NPI:1538149190
Name:CUMMINGS, DIANE H (CNP)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:H
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 B VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:ACOMA
Mailing Address - State:NM
Mailing Address - Zip Code:87034
Mailing Address - Country:US
Mailing Address - Phone:505-552-5300
Mailing Address - Fax:505-552-5490
Practice Address - Street 1:7801 ACADEMY RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3379
Practice Address - Country:US
Practice Address - Phone:505-272-2700
Practice Address - Fax:505-272-6308
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR47159363LF0000X
NM508367A00000X
NMCNP1154363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM86109766Medicaid
NMH3451Medicaid
NMH3451Medicaid