Provider Demographics
NPI:1205404225
Name:YANCER, DIANE LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LYNN
Last Name:YANCER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4967 PARDEE RD
Mailing Address - Street 2:
Mailing Address - City:WEBBERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48892-9710
Mailing Address - Country:US
Mailing Address - Phone:269-753-4535
Mailing Address - Fax:
Practice Address - Street 1:4830 CENTRAL PARK DR
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2089
Practice Address - Country:US
Practice Address - Phone:517-349-3600
Practice Address - Fax:517-349-3602
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704334325163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse