Jordan-Wagner, Diane

Jordan-Wagner, Diane is an individual health care provider with primary practice located at 1429 N 6Th St , Terre Haute IN 47804-1037. She recently has only one registered license in Allopathic & Osteopathic Physicians / Allergy & Immunology, which is considered as her primary health care specialty. Jordan-Wagner, Diane can be contacted via phone (812) 232-0564.

Contact Information

Primary practice address
1429 N 6Th St Terre Haute IN 47804-1037
Phone: (812) 232-0564
Fax: (812) 235-3330
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Allergy & Immunology 207RA0201X 01056292A Indiana
Allopathic & Osteopathic Physicians / Allergy & Immunology 207RA0201X 36106006 Illinois

Profile Details

NPI number 1013025097
LBN Legal business name Jordan-Wagner, Diane
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 29th, 2006
Last updated Mar 14th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013025097 NPPES
Other 030005377 RAILROAD MCARE PALAMETTO
MEDICAID 200392780 RAILROAD MCARE PALAMETTO
Other P00844293 RAILROAD MCARE PALAMETTO
Other 000000230225 RAILROAD MCARE PALAMETTO
MEDICAID 200392780Q RAILROAD MCARE PALAMETTO

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