Provider Demographics
NPI:1073198024
Name:DIAZ, HEIDI (LPN)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:DIAZ
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 1:10 EMBANKMENT ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-4731
Mailing Address - Country:US
Mailing Address - Phone:978-687-6300
Mailing Address - Fax:
Practice Address - Street 1:10 EMBANKMENT ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-4731
Practice Address - Country:US
Practice Address - Phone:978-687-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH017543-22164W00000X
MALN52079164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse