Provider Demographics
NPI:1629146899
Name:ROE, DIANE LEE MYERS (LPN)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LEE MYERS
Last Name:ROE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:LEE
Other - Last Name:MYERS-ROE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:146 PARKLAND AVE SW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3812
Mailing Address - Country:US
Mailing Address - Phone:614-209-2427
Mailing Address - Fax:
Practice Address - Street 1:146 PARKLAND AVE SW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3812
Practice Address - Country:US
Practice Address - Phone:614-209-2427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN073305164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN073305OtherLPN