Provider Demographics
NPI:1689857633
Name:GARNEAU, DIANE LOUISE (BCHIS BOARD CERTIFIE)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LOUISE
Last Name:GARNEAU
Suffix:
Gender:F
Credentials:BCHIS BOARD CERTIFIE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133
Mailing Address - Country:US
Mailing Address - Phone:937-393-4558
Mailing Address - Fax:937-393-3889
Practice Address - Street 1:215 N HIGH STREET
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133
Practice Address - Country:US
Practice Address - Phone:937-393-4558
Practice Address - Fax:937-393-3889
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2145332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0349019Medicaid