Provider Demographics
NPI:1952674152
Name:PRESUTTO, DIANE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:PRESUTTO
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 1:4345 SANTINA WAY
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2197
Mailing Address - Country:US
Mailing Address - Phone:440-960-2977
Mailing Address - Fax:
Practice Address - Street 1:2521 E 32ND ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-2131
Practice Address - Country:US
Practice Address - Phone:440-787-1016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN084379164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse