Basic Information
| Provider Information | |||||||||
| NPI: | 1629170394 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCRIBNER | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 LAPEER | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486071208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897596464 | ||||||||
| FaxNumber: | 9893998233 | ||||||||
| Practice Location | |||||||||
| Address1: | 239 N. STATE RD | ||||||||
| Address2: | SUITE A, | ||||||||
| City: | OWOSSO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897294848 | ||||||||
| FaxNumber: | 9897294849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2006 | ||||||||
| LastUpdateDate: | 03/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601003092 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 175811 | 01 | MI | GREAT LAKES HEALTH PLAN OF MICHIGAN | OTHER | 54507 | 01 | MI | HEALTH PLAN OF MICHIGAN | OTHER | 381908328 | 01 | TRICARE | OTHER | 381908328-433 | 01 | MI | CARE SOURCE OF MICHIGAN | OTHER | 080G310660 | 01 | MI | BLUE CROSS BLUE SHIELD OF MICHIGAN | OTHER |