Provider Demographics
NPI:1114362191
Name:ANSON, DIANNA B (NURSE)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:B
Last Name:ANSON
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 PADDOCK CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-2326
Mailing Address - Country:US
Mailing Address - Phone:502-314-2801
Mailing Address - Fax:
Practice Address - Street 1:2512 PADDOCK CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-2326
Practice Address - Country:US
Practice Address - Phone:502-314-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2042608164W00000X
IN27063583A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse