Provider Demographics
NPI:1477110377
Name:WILKINS, DIANE M (RN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:WILKINS
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 1:2136 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-3232
Mailing Address - Country:US
Mailing Address - Phone:440-522-6949
Mailing Address - Fax:
Practice Address - Street 1:2136 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-3232
Practice Address - Country:US
Practice Address - Phone:440-522-6949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-26
Last Update Date:2019-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.406969163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse