Provider Demographics
NPI:1164788246
Name:POWERS, DIANE MARIE (DOULA)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:POWERS
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 HANCOCK CT
Mailing Address - Street 2:BOX 353
Mailing Address - City:GARDEN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95633-9729
Mailing Address - Country:US
Mailing Address - Phone:530-333-9153
Mailing Address - Fax:
Practice Address - Street 1:5520 HANCOCK CT
Practice Address - Street 2:BOX 353
Practice Address - City:GARDEN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95633-9729
Practice Address - Country:US
Practice Address - Phone:530-333-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X-DOULA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula