Provider Demographics
NPI:1639577968
Name:WARD, DIANA JEAN
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:JEAN
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:JEAN
Other - Last Name:HARDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9100 W FLAMINGO RD UNIT 2023
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6404
Mailing Address - Country:US
Mailing Address - Phone:435-990-1034
Mailing Address - Fax:
Practice Address - Street 1:9100 W FLAMINGO RD UNIT 2023
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6404
Practice Address - Country:US
Practice Address - Phone:435-990-1034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator