Provider Demographics
NPI:1598084337
Name:WILLIAMS, DIANA RENEA
Entity Type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:RENEA
Last Name:WILLIAMS
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 1:1115 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1815
Mailing Address - Country:US
Mailing Address - Phone:330-224-9634
Mailing Address - Fax:330-451-1625
Practice Address - Street 1:1115 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1815
Practice Address - Country:US
Practice Address - Phone:330-224-9634
Practice Address - Fax:330-451-1625
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program