Provider Demographics
NPI:1518200716
Name:DIAS, AMOR M (LPN)
Entity Type:Individual
Prefix:MS
First Name:AMOR
Middle Name:M
Last Name:DIAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:AMOR
Other - Middle Name:M
Other - Last Name:LUZAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:3350 COLLINGWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43610-1173
Mailing Address - Country:US
Mailing Address - Phone:419-367-9254
Mailing Address - Fax:
Practice Address - Street 1:3350 COLLINGWOOD BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43610-1173
Practice Address - Country:US
Practice Address - Phone:419-367-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144854164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse