Provider Demographics
NPI:1851891808
Name:MARSHALL, DIANE L (RN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:LYNN
Other - Last Name:DERTEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2524 FM 3427
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-6892
Mailing Address - Country:US
Mailing Address - Phone:719-930-6589
Mailing Address - Fax:
Practice Address - Street 1:2524 FM 3427
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-6892
Practice Address - Country:US
Practice Address - Phone:719-930-6589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX938881163WH0200X
TX93881163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health