Provider Demographics
NPI:1316371982
Name:STEVENS, DIANNA SUE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DIANNA
Middle Name:SUE
Last Name:STEVENS
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 1:181 JUDE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-8235
Mailing Address - Country:US
Mailing Address - Phone:606-673-3841
Mailing Address - Fax:
Practice Address - Street 1:628 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1471
Practice Address - Country:US
Practice Address - Phone:606-789-6966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2031004164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse