Individual
DIANNA EASTLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CANP
Contact information
Practice address
6500 EXCELSIOR BLVD, ST LOUIS PARK, MN 55426-4702
(952) 993-6600
Mailing address
10685 99TH PL N, MAPLE GROVE, MN 55369-3471
(763) 315-8776
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2008005175
MN
Other
Enumeration date
11/17/2008
Last updated
11/17/2008
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