Provider Demographics
NPI:1467683359
Name:KEITH, DIANA LINN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LINN
Last Name:KEITH
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 1:9894 DOYLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST EDMESTON
Mailing Address - State:NY
Mailing Address - Zip Code:13485-2952
Mailing Address - Country:US
Mailing Address - Phone:315-899-7789
Mailing Address - Fax:
Practice Address - Street 1:9894 DOYLE RD
Practice Address - Street 2:
Practice Address - City:WEST EDMESTON
Practice Address - State:NY
Practice Address - Zip Code:13485-2952
Practice Address - Country:US
Practice Address - Phone:315-899-7789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268531164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse