Provider Demographics
NPI:1174279913
Name:FAULKNER, DYAMOND M
Entity Type:Individual
Prefix:
First Name:DYAMOND
Middle Name:M
Last Name:FAULKNER
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 1:11651 NORBOURNE DR APT 1610
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-4469
Mailing Address - Country:US
Mailing Address - Phone:513-370-9888
Mailing Address - Fax:
Practice Address - Street 1:11651 NORBOURNE DR APT 1610
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-4469
Practice Address - Country:US
Practice Address - Phone:513-370-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health