Provider Demographics
NPI:1396025078
Name:RAYSANDERS, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:RAYSANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:VILLAGE
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1127
Mailing Address - Country:US
Mailing Address - Phone:469-279-4104
Mailing Address - Fax:
Practice Address - Street 1:1728 WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:VILLAGE
Practice Address - State:OK
Practice Address - Zip Code:73120-1127
Practice Address - Country:US
Practice Address - Phone:469-279-4104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker