Provider Demographics
NPI:1295208973
Name:MADISON, DIAMOND DEANNA (LPN)
Entity Type:Individual
Prefix:
First Name:DIAMOND
Middle Name:DEANNA
Last Name:MADISON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 SOUTH AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-1060
Mailing Address - Country:US
Mailing Address - Phone:585-313-3058
Mailing Address - Fax:
Practice Address - Street 1:390 SOUTH AVE APT 107
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1060
Practice Address - Country:US
Practice Address - Phone:585-313-3058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-06
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333993164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse