Provider Demographics
NPI:1639759640
Name:DUTY, DIANA DENISE
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:DENISE
Last Name:DUTY
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 1:1253 RACCOON RD
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-8364
Mailing Address - Country:US
Mailing Address - Phone:740-441-5322
Mailing Address - Fax:
Practice Address - Street 1:1235 RACCOON RD
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-8364
Practice Address - Country:US
Practice Address - Phone:740-245-2844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide