Provider Demographics
NPI:1679188999
Name:POGUE, DIANA L
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:POGUE
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 1:11380 BRADY LN
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-2832
Mailing Address - Country:US
Mailing Address - Phone:216-533-2694
Mailing Address - Fax:
Practice Address - Street 1:11380 BRADY LN
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44149-2832
Practice Address - Country:US
Practice Address - Phone:216-533-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care