Provider Demographics
NPI:1497121438
Name:FRALICK, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:FRALICK
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:KAY
Other - Last Name:FRALICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:74 W POSSUM RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45506-3631
Mailing Address - Country:US
Mailing Address - Phone:937-408-0293
Mailing Address - Fax:
Practice Address - Street 1:74 W POSSUM RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45506-3631
Practice Address - Country:US
Practice Address - Phone:937-408-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.150916163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse