Provider Demographics
NPI:1700419710
Name:HALLAGAN, DIANE P
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:P
Last Name:HALLAGAN
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 1:31737 TRADEWINDS DR
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2443
Mailing Address - Country:US
Mailing Address - Phone:440-752-9836
Mailing Address - Fax:
Practice Address - Street 1:2010 RECREATION LN
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1169
Practice Address - Country:US
Practice Address - Phone:440-752-9836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator