Provider Demographics
NPI:1952061400
Name:RODGERS, DIANE
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:RODGERS
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 1:2080 PALOUSE DR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-9019
Mailing Address - Country:US
Mailing Address - Phone:614-738-5979
Mailing Address - Fax:
Practice Address - Street 1:2080 PALOUSE DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-9019
Practice Address - Country:US
Practice Address - Phone:614-738-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-26
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker