Provider Demographics
NPI:1184994931
Name:PIERCE, DIANE SUSAN (LPN)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:SUSAN
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11833 FRESHLEY AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601
Mailing Address - Country:US
Mailing Address - Phone:330-206-9934
Mailing Address - Fax:
Practice Address - Street 1:11833 FRESHLEY AVE NE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601
Practice Address - Country:US
Practice Address - Phone:330-206-9934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN123933IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse