Provider Demographics
NPI:1164655627
Name:MOOREFIELD, DIANE T (RN, MS)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:T
Last Name:MOOREFIELD
Suffix:
Gender:F
Credentials:RN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SCHUCKS RD
Mailing Address - Street 2:
Mailing Address - City:BELAIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015
Mailing Address - Country:US
Mailing Address - Phone:410-642-2411
Mailing Address - Fax:410-642-1825
Practice Address - Street 1:1600 SCHUCKS RD
Practice Address - Street 2:
Practice Address - City:BELAIR
Practice Address - State:MD
Practice Address - Zip Code:21015
Practice Address - Country:US
Practice Address - Phone:410-642-2411
Practice Address - Fax:410-642-1825
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR039594163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health