Provider Demographics
NPI:1043084916
Name:DIMOLA, DIANE MARIE (MPH, RN, BSN, CPN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:DIMOLA
Suffix:
Gender:F
Credentials:MPH, RN, BSN, CPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 JEFFERSON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37938-4446
Mailing Address - Country:US
Mailing Address - Phone:609-439-1809
Mailing Address - Fax:
Practice Address - Street 1:1924 ALCOA HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1511
Practice Address - Country:US
Practice Address - Phone:865-305-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN258595163WP0200X, 163WX0003X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient