Provider Demographics
NPI:1083027015
Name:OFLYNNE, DIANA RUNE
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:RUNE
Last Name:OFLYNNE
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 1:4832 CHASE HILL DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-8120
Mailing Address - Country:US
Mailing Address - Phone:866-944-3767
Mailing Address - Fax:866-944-3767
Practice Address - Street 1:4832 CHASE HILL DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-8120
Practice Address - Country:US
Practice Address - Phone:866-944-3767
Practice Address - Fax:866-944-3767
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist