Provider Demographics
NPI:1912554445
Name:RAPPA, DIANA LEE (RN RETIRED)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LEE
Last Name:RAPPA
Suffix:
Gender:F
Credentials:RN RETIRED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 MCEVER PARK CIR
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-6651
Mailing Address - Country:US
Mailing Address - Phone:352-275-1071
Mailing Address - Fax:
Practice Address - Street 1:3303 MCEVER PARK CIR
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-6651
Practice Address - Country:US
Practice Address - Phone:352-275-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider