Provider Demographics
NPI:1669513610
Name:RYLAND, DIANE (CRNA)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:RYLAND
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11225
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-2225
Mailing Address - Country:US
Mailing Address - Phone:423-892-5602
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:2624 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:ROCKY FACE
Practice Address - State:GA
Practice Address - Zip Code:30740-9071
Practice Address - Country:US
Practice Address - Phone:423-488-3283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN127990163W00000X
GARN091337163W00000X
TNAPN10810367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAN375502OtherWELLCARE (GA MEDICAID)
TNP00213091OtherRAILROAD MEDICARE
TN4100326OtherBLUE CROSS BLUE SHIELD TN
GA935938084AMedicaid
TN3633933Medicaid
GAN375502OtherWELLCARE (GA MEDICAID)