Provider Demographics
NPI:1437371689
Name:JOHNSON, DIANE FRANCES (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:FRANCES
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:DIANE
Other - Middle Name:FRANCES
Other - Last Name:DUTHOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:121 WASHINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:BALATON
Mailing Address - State:MN
Mailing Address - Zip Code:56115
Mailing Address - Country:US
Mailing Address - Phone:507-829-2206
Mailing Address - Fax:
Practice Address - Street 1:106 NORTH 4TH AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0332037164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse