Provider Demographics
NPI:1578956553
Name:MCINTYRE, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 E HORIZON RIDGE PKWY
Mailing Address - Street 2:103
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-7929
Mailing Address - Country:US
Mailing Address - Phone:702-608-8811
Mailing Address - Fax:702-608-8598
Practice Address - Street 1:40 E HORIZON RIDGE PKWY
Practice Address - Street 2:103
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-7929
Practice Address - Country:US
Practice Address - Phone:702-608-8811
Practice Address - Fax:702-608-8598
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-14
Last Update Date:2015-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20141541165253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care