Provider Demographics
NPI:1144407305
Name:DIEDRICH, DIANA LAUREN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LAUREN
Last Name:DIEDRICH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 CLAREY BLVD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-3212
Mailing Address - Country:US
Mailing Address - Phone:808-450-3086
Mailing Address - Fax:
Practice Address - Street 1:4425 CLAREY BLVD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-3212
Practice Address - Country:US
Practice Address - Phone:808-450-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15809164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse