Provider Demographics
NPI:1477948404
Name:DIANA, TRACY JANE (LVN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:JANE
Last Name:DIANA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6741 SANTA CATALINA AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1323
Mailing Address - Country:US
Mailing Address - Phone:714-507-6921
Mailing Address - Fax:
Practice Address - Street 1:6741 SANTA CATALINA AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1323
Practice Address - Country:US
Practice Address - Phone:714-507-6921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 192750164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse