Provider Demographics
NPI:1558956706
Name:BRADY, DIANE LYNN (RN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LYNN
Last Name:BRADY
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 1:1173 TRIPLE CROWN CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29429-4990
Mailing Address - Country:US
Mailing Address - Phone:716-969-7025
Mailing Address - Fax:
Practice Address - Street 1:1173 TRIPLE CROWN CT
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29429-4990
Practice Address - Country:US
Practice Address - Phone:716-969-7025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC243437163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse