Provider Demographics
NPI:1578584256
Name:WHITE, DIANNA LYNN (FNP)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:LYNN
Last Name:WHITE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DIANNA
Other - Middle Name:LYNN
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 740015
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0015
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:7028 HIGHWAY 85
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2946
Practice Address - Country:US
Practice Address - Phone:470-444-3136
Practice Address - Fax:470-298-7730
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704160906363LF0000X
GARN221863363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1144371279Medicaid
MI1871645309Medicaid
MI1396839981Medicaid