Provider Demographics
NPI:1679099956
Name:GRIENER, DIANE MIPRO (FNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MIPRO
Last Name:GRIENER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:ELIZABETH
Other - Last Name:MIPRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:130 DESIARD ST STE 355
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7363
Mailing Address - Country:US
Mailing Address - Phone:318-807-7875
Mailing Address - Fax:318-812-6603
Practice Address - Street 1:13348 COURSEY BLVD STE D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4970
Practice Address - Country:US
Practice Address - Phone:225-442-7939
Practice Address - Fax:225-777-1040
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131607363LF0000X
LAAP09582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily