Provider Demographics
NPI:1073217964
Name:MCCAULEY, DIANA L (RN)
Entity Type:Individual
Prefix:MR
First Name:DIANA
Middle Name:L
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 49M
Mailing Address - Street 2:
Mailing Address - City:VALLEY BEND
Mailing Address - State:WV
Mailing Address - Zip Code:26293-9718
Mailing Address - Country:US
Mailing Address - Phone:304-642-4380
Mailing Address - Fax:304-637-5606
Practice Address - Street 1:909 GORMAN AVE STE 6
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3100
Practice Address - Country:US
Practice Address - Phone:130-463-7363
Practice Address - Fax:304-637-5606
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28709163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health