Provider Demographics
NPI:1588796577
Name:ROWLAND, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:ROWLAND
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 1:801 WALDEN DR
Mailing Address - Street 2:APT C
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6829
Mailing Address - Country:US
Mailing Address - Phone:910-632-6871
Mailing Address - Fax:
Practice Address - Street 1:801 WALDEN DR
Practice Address - Street 2:APT C
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6829
Practice Address - Country:US
Practice Address - Phone:910-632-6871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409019Medicaid