Provider Demographics
NPI:1174553465
Name:PITTMAN, DIANNE DENISE (MSN, ACNP, RN)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:DENISE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:MSN, ACNP, RN
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Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:506 W WINDCREST ST STE 300
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4639
Practice Address - Country:US
Practice Address - Phone:830-990-0255
Practice Address - Fax:830-997-7569
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX541246363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y0398OtherBCBS
TX335303902Medicaid
Q70001Medicare UPIN