Provider Demographics
NPI:1801228655
Name:YEAGLEY, DIANE LEE (LPN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LEE
Last Name:YEAGLEY
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 1:136 E INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:OH
Mailing Address - Zip Code:44672-1431
Mailing Address - Country:US
Mailing Address - Phone:330-614-4000
Mailing Address - Fax:
Practice Address - Street 1:136 E INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:OH
Practice Address - Zip Code:44672-1431
Practice Address - Country:US
Practice Address - Phone:330-614-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-04
Last Update Date:2013-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.136740-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse