Provider Demographics
NPI:1821041963
Name:MC CARTHY, DIANE RITA (LPN)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:RITA
Last Name:MC CARTHY
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 1:18035 CLIFFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-4235
Mailing Address - Country:US
Mailing Address - Phone:216-402-8128
Mailing Address - Fax:
Practice Address - Street 1:18035 CLIFFSIDE
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-7961
Practice Address - Country:US
Practice Address - Phone:216-402-8128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN073726164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2541397Medicaid