Provider Demographics
NPI:1972362846
Name:YOUNGCOURT, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:YOUNGCOURT
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 1:10 MAPLE HILL AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-1590
Mailing Address - Country:US
Mailing Address - Phone:304-250-4545
Mailing Address - Fax:
Practice Address - Street 1:216 CLIFFTOP DR
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-8893
Practice Address - Country:US
Practice Address - Phone:304-703-3774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant