Provider Demographics
NPI:1922350560
Name:SEABROOK, DIANE MARIE (BSN, MA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:SEABROOK
Suffix:
Gender:F
Credentials:BSN, MA
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:LEECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:650 WHITNEY RANCH DR
Mailing Address - Street 2:APT 3124
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2600
Mailing Address - Country:US
Mailing Address - Phone:858-603-0835
Mailing Address - Fax:
Practice Address - Street 1:650 WHITNEY RANCH DR
Practice Address - Street 2:APT 3124
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2600
Practice Address - Country:US
Practice Address - Phone:858-603-0835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner