Individual
DIANE H TODD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4578
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4578
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
200350035NPACNPPP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
028112
—
OR
01
—
1407812365
NBMC GROUP NPI
OR
01
—
161133
NBMC GROUP MEDICAID
OR
01
—
93-0635514
NBMC GROUP TAX ID FOR BILLING
OR
01
—
R0000WFBTV
NBMC GROUP MEDICARE
OR
Enumeration date
05/24/2006
Last updated
07/21/2015
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