Provider Demographics
NPI:1124378948
Name:LETTERLE, DIANE MARIE (RN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:LETTERLE
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 1:708 TINKERS LN
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44067-2306
Mailing Address - Country:US
Mailing Address - Phone:330-592-2657
Mailing Address - Fax:
Practice Address - Street 1:708 TINKERS LANE
Practice Address - Street 2:
Practice Address - City:SAGAMORE HILLS
Practice Address - State:OH
Practice Address - Zip Code:44067
Practice Address - Country:US
Practice Address - Phone:440-953-6032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN266512163W00000X, 163WC3500X, 163WE0003X, 163WM0705X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care