Provider Demographics
NPI:1437241429
Name:EIDE, DIANE LYNN (RN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LYNN
Last Name:EIDE
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 1:22449 ELSTON AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-5501
Mailing Address - Country:US
Mailing Address - Phone:651-464-7747
Mailing Address - Fax:
Practice Address - Street 1:22449 ELSTON AVE
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-5501
Practice Address - Country:US
Practice Address - Phone:651-464-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR113464 5251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health