Provider Demographics
NPI:1003230897
Name:DIAMOND, MARY STEPHANIA (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:STEPHANIA
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:STEPHANIA
Other - Last Name:BURDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:351 HARTNELL AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1845
Mailing Address - Country:US
Mailing Address - Phone:530-247-7910
Mailing Address - Fax:530-229-0024
Practice Address - Street 1:351 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1845
Practice Address - Country:US
Practice Address - Phone:530-247-7910
Practice Address - Fax:530-229-0024
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA647777163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse