Provider Demographics
NPI:1558751057
Name:MUNN, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MUNN
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 1:195 CONSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-1151
Mailing Address - Country:US
Mailing Address - Phone:540-381-4037
Mailing Address - Fax:540-585-3151
Practice Address - Street 1:195 CONSTON AVE
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-1151
Practice Address - Country:US
Practice Address - Phone:540-381-4037
Practice Address - Fax:540-585-3151
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician