Provider Demographics
NPI:1205188646
Name:ELA, DIANE (RN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ELA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:SIEDSCHLAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:15200 RAINBOW ONE ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-1740
Mailing Address - Country:US
Mailing Address - Phone:512-266-7440
Mailing Address - Fax:
Practice Address - Street 1:15200 RAINBOW ONE ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-1740
Practice Address - Country:US
Practice Address - Phone:512-266-7440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX436215163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse