Provider Demographics
NPI:1346379518
Name:HART, DIANA L (RN)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:L
Last Name:HART
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 1:2452 SHEA DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-3865
Mailing Address - Country:US
Mailing Address - Phone:478-788-1102
Mailing Address - Fax:478-788-1102
Practice Address - Street 1:2452 SHEA DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-3865
Practice Address - Country:US
Practice Address - Phone:478-788-1102
Practice Address - Fax:478-788-1102
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANHA004999163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management