Provider Demographics
NPI:1942856950
Name:JARGO, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:JARGO
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 1:462 W. DEGROAT ST. BOX 519
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:52069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:462 W. DEGROAT ST.
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:IA
Practice Address - Zip Code:52069
Practice Address - Country:US
Practice Address - Phone:563-212-1996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider