| Doctor Name: | DIANE JORDAN-WAGNER |
| NPI Number: | 1013025097 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 36106006 |
| Business Practice Address: | 1429 N 6th St Terre Haute, IN - 478041037 |
| Business Phone Number: | 8122320564 |
| Business Fax Number: | 8122353330 |
| Mailing Address: | 221 S 6th St, TERRE HAUTE |
| State: | IN |
| Postal Code: | 478074214 |
| Phone Number: | 8122320564 |
| Fax Number: | 8122353330 |
| NPI Enumeration Date: | 08/29/2006 |
| NPI Last Update Date: | 03/14/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RA0201X |
| License Number: | 36106006 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Allergy & Immunology |
| Taxonomy Definition: | An internist doctor of osteopathy that specializes in the treatment of allergy and immunologic disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Special Qualifications in the field of Allergy & Immunology. |