Individual
DIANE M DREVS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3250 PLAZA DR, SOUTH SIOUX CITY, NE 68776-3144
(402) 412-4220
(402) 494-1365
Mailing address
814 PIERCE ST, SUITE 102, SIOUX CITY, IA 51101-1058
(712) 226-2600
(712) 226-2605
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
696
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13646
WELLMARK
IA
Enumeration date
07/09/2006
Last updated
03/08/2011
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