Provider Demographics
NPI:1922545110
Name:GORMAN, DIANA ROCHELLE (LPN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ROCHELLE
Last Name:GORMAN
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 1:1464 LAKELAND AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1561
Mailing Address - Country:US
Mailing Address - Phone:234-521-9653
Mailing Address - Fax:
Practice Address - Street 1:1464 LAKELAND AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1561
Practice Address - Country:US
Practice Address - Phone:234-521-9653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151464164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse