Provider Demographics
NPI:1306000971
Name:JOHNSON, DIANE GAIL (MT (ASCP))
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:GAIL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MT (ASCP)
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:JOHNSON
Other - Last Name:HOPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT (ASCP)
Mailing Address - Street 1:420 N CENTER ST
Mailing Address - Street 2:LABORATORY
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5046
Mailing Address - Country:US
Mailing Address - Phone:828-315-3769
Mailing Address - Fax:
Practice Address - Street 1:420 N CENTER ST
Practice Address - Street 2:LABORATORY
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5046
Practice Address - Country:US
Practice Address - Phone:828-315-3769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT01435652246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist