Provider Demographics
NPI:1326350059
Name:BECKNER, DIANE E (LPN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:E
Last Name:BECKNER
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 1:2898 MOUNT HOLYOKE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2913
Mailing Address - Country:US
Mailing Address - Phone:614-847-9730
Mailing Address - Fax:
Practice Address - Street 1:2898 MOUNT HOLYOKE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2913
Practice Address - Country:US
Practice Address - Phone:614-847-9730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN130110-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3080875Medicaid