Provider Demographics
NPI:1528394780
Name:MONETTE, DIANA RENEE
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:RENEE
Last Name:MONETTE
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 1:485 DUNHAM RD
Mailing Address - Street 2:
Mailing Address - City:CHUCKEY
Mailing Address - State:TN
Mailing Address - Zip Code:37641-6716
Mailing Address - Country:US
Mailing Address - Phone:423-257-6994
Mailing Address - Fax:423-257-6994
Practice Address - Street 1:485 DUNHAM RD
Practice Address - Street 2:
Practice Address - City:CHUCKEY
Practice Address - State:TN
Practice Address - Zip Code:37641-6716
Practice Address - Country:US
Practice Address - Phone:423-257-6994
Practice Address - Fax:423-257-6994
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
H445404Medicare UPIN