Provider Demographics
NPI:1871727545
Name:KLUTZ, DIANE LOUISE (RN PHD FNP-BC)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:LOUISE
Last Name:KLUTZ
Suffix:
Gender:F
Credentials:RN PHD FNP-BC
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:MUMPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8300 OCEAN DRIVE
Mailing Address - Street 2:UNIT 5715
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-5715
Mailing Address - Country:US
Mailing Address - Phone:361-825-2601
Mailing Address - Fax:361-825-6030
Practice Address - Street 1:8300 OCEAN DRIVE
Practice Address - Street 2:UNIT 5715
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-5715
Practice Address - Country:US
Practice Address - Phone:361-825-2601
Practice Address - Fax:361-825-6030
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX424922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily