Provider Demographics
NPI:1568984557
Name:DEKOSTER, DIANE MARIE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:DEKOSTER
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 1:11657 SCOTT PARK RD
Mailing Address - Street 2:
Mailing Address - City:DELTON
Mailing Address - State:MI
Mailing Address - Zip Code:49046-8579
Mailing Address - Country:US
Mailing Address - Phone:269-317-7711
Mailing Address - Fax:
Practice Address - Street 1:11657 SCOTT PARK RD
Practice Address - Street 2:
Practice Address - City:DELTON
Practice Address - State:MI
Practice Address - Zip Code:49046-8579
Practice Address - Country:US
Practice Address - Phone:269-317-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
123456789OtherN/A