Provider Demographics
NPI:1033454053
Name:TEMPLE, DIANNE JOHNSON
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:JOHNSON
Last Name:TEMPLE
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 1:930 WOODLANE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-1110
Mailing Address - Country:US
Mailing Address - Phone:609-227-3252
Mailing Address - Fax:
Practice Address - Street 1:930 WOODLANE RD
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-1110
Practice Address - Country:US
Practice Address - Phone:609-227-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-02
Last Update Date:2012-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO10647400163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse