Individual
DIANA LYNN HACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2157 GREEN VALLEY RD, BRIDGEPORT, WV 26330
(304) 699-4103
Mailing address
2157 GREEN VALLEY RD, BRIDGEPORT, WV 26330-6983
(304) 699-4103
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
39055
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0067524000
—
WV
01
—
0207026000
GROUP MEDICAID
WV
01
—
9333201
MEDICARE GROUP
WV
Enumeration date
01/16/2007
Last updated
05/14/2018
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