Provider Demographics
NPI:1003105248
Name:GEDEON, DIANA LYNN (RN, LSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:GEDEON
Suffix:
Gender:F
Credentials:RN, LSW
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:GEDEON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, LSW
Mailing Address - Street 1:16922 S CANAAN RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-9461
Mailing Address - Country:US
Mailing Address - Phone:740-592-6074
Mailing Address - Fax:740-592-6074
Practice Address - Street 1:16922 S CANAAN RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-9461
Practice Address - Country:US
Practice Address - Phone:740-592-6074
Practice Address - Fax:740-592-6074
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN307502163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse