Provider Demographics
NPI:1134319437
Name:DEUTSCH, DIANN ROSELLEN (RN)
Entity Type:Individual
Prefix:MS
First Name:DIANN
Middle Name:ROSELLEN
Last Name:DEUTSCH
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 1:2220 DALE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46819-1604
Mailing Address - Country:US
Mailing Address - Phone:260-747-8289
Mailing Address - Fax:
Practice Address - Street 1:2220 DALE DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46819-1604
Practice Address - Country:US
Practice Address - Phone:260-747-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28172915A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse