Provider Demographics
NPI:1548606973
Name:VICKERS, DIANA WOODWARD (RN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:WOODWARD
Last Name:VICKERS
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 1:1015 E BENRICH DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-8352
Mailing Address - Country:US
Mailing Address - Phone:860-922-6035
Mailing Address - Fax:
Practice Address - Street 1:40 S GILBERT RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1047
Practice Address - Country:US
Practice Address - Phone:480-545-2117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN162725163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool