Provider Demographics
NPI:1477032571
Name:PEMBERTON, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:PEMBERTON
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 1:165 TOUCHSTONE RD
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098
Mailing Address - Country:US
Mailing Address - Phone:214-738-8560
Mailing Address - Fax:469-626-9670
Practice Address - Street 1:1255 W 15TH ST STE 1025
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7253
Practice Address - Country:US
Practice Address - Phone:972-673-0404
Practice Address - Fax:469-626-9670
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX650434163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management