Provider Demographics
NPI:1558669929
Name:CUMMINS, DIANE MARY (RN, CCDC IIIE)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARY
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:RN, CCDC IIIE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 S EDWIN C MOSES BLVD.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417
Mailing Address - Country:US
Mailing Address - Phone:937-461-1376
Mailing Address - Fax:937-341-8198
Practice Address - Street 1:921 S. EDWIN C MOSES BLVD.
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417
Practice Address - Country:US
Practice Address - Phone:937-461-1376
Practice Address - Fax:937-341-8198
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH892645101YA0400X
OHRN-149812163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care