Provider Demographics
NPI:1457082711
Name:ROSS, DIANE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:ROSS
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 1:2100 ROANOKE ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-2512
Mailing Address - Country:US
Mailing Address - Phone:540-299-1149
Mailing Address - Fax:540-394-7105
Practice Address - Street 1:2100 ROANOKE ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-2512
Practice Address - Country:US
Practice Address - Phone:540-299-1149
Practice Address - Fax:540-394-7105
Is Sole Proprietor?:No
Enumeration Date:2022-06-18
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002078945164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse