Provider Demographics
NPI:1821216359
Name:WARFIELD, DIANE CARRIE (DT)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:CARRIE
Last Name:WARFIELD
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-4868
Mailing Address - Country:US
Mailing Address - Phone:618-277-9532
Mailing Address - Fax:618-277-9532
Practice Address - Street 1:2821 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-4868
Practice Address - Country:US
Practice Address - Phone:618-277-9532
Practice Address - Fax:618-277-9532
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILDW42940603222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL199OtherDT