Provider Demographics
NPI:1235935222
Name:HEAD, DIANNE YVONNE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:YVONNE
Last Name:HEAD
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:YVONNE
Other - Last Name:TRAMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1672 S WOODSAGE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8332
Mailing Address - Country:US
Mailing Address - Phone:208-515-2273
Mailing Address - Fax:208-515-2274
Practice Address - Street 1:1672 S WOODSAGE AVE STE 120
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8332
Practice Address - Country:US
Practice Address - Phone:208-515-2273
Practice Address - Fax:208-515-2274
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3861370363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID3861370OtherIDAHO BOARD OF NURSING