Provider Demographics
NPI:1891184032
Name:DIVER, LADEANA
Entity Type:Individual
Prefix:
First Name:LADEANA
Middle Name:
Last Name:DIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:PITSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45358-5049
Mailing Address - Country:US
Mailing Address - Phone:937-875-7085
Mailing Address - Fax:
Practice Address - Street 1:312 BAKER STREET
Practice Address - Street 2:
Practice Address - City:PITSBURG
Practice Address - State:OH
Practice Address - Zip Code:45358-1260
Practice Address - Country:US
Practice Address - Phone:937-875-7085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN281361163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse