Provider Demographics
NPI:1174166870
Name:ANDERSON-MORRIS, DIANE LORRAINE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LORRAINE
Last Name:ANDERSON-MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14097 HUNTINGTON LN
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-7288
Mailing Address - Country:US
Mailing Address - Phone:913-683-5298
Mailing Address - Fax:
Practice Address - Street 1:14097 HUNTINGTON LN
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-7288
Practice Address - Country:US
Practice Address - Phone:913-683-5298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider