Provider Demographics
NPI:1679859243
Name:KNOX, DIANA ZETHBORA (LPN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ZETHBORA
Last Name:KNOX
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6004 DAUPHINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-2144
Mailing Address - Country:US
Mailing Address - Phone:504-547-4899
Mailing Address - Fax:
Practice Address - Street 1:6004 DAUPHINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-2144
Practice Address - Country:US
Practice Address - Phone:504-547-4899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2951251164W00000X
NY1679859243164W00000X
LA20152463164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1679859243Medicaid