Provider Demographics
NPI:1164644712
Name:HART, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:HART
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 1:685 ST.RT.83
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45715
Mailing Address - Country:US
Mailing Address - Phone:740-558-2105
Mailing Address - Fax:
Practice Address - Street 1:963 TICK HILL RD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:OH
Practice Address - Zip Code:45744-7486
Practice Address - Country:US
Practice Address - Phone:740-525-3415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2702516374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide