Provider Demographics
NPI:1821643578
Name:DIAMOND, STEPHANIE RENEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RENEE
Last Name:DIAMOND
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 1:822 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-2044
Mailing Address - Country:US
Mailing Address - Phone:276-870-3862
Mailing Address - Fax:
Practice Address - Street 1:822 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-2044
Practice Address - Country:US
Practice Address - Phone:276-870-3862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002073673164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse