Individual
JERI DINE
Active
Individual
JERI DINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71000423A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71000423A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000041022
M PLAN
IN
01
—
000000550394
ANTHEM
IN
01
—
0011953-21
NP CERTIFICATION
IN
01
—
11478722
CAQH
IN
05
—
200307870
—
IN
01
—
28065854A
RN LICENSE
IN
01
—
35-4994904
TID
IN
01
—
71000423B
CSR
IN
01
—
P00068634
RR MEDICARE
IN
Enumeration date
11/28/2007
Last updated
03/07/2023
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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