Provider Demographics
NPI:1982205266
Name:EASTMAN, DIANNE LYNN
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:LYNN
Last Name:EASTMAN
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 1:3783 PACKS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOPE
Mailing Address - State:WV
Mailing Address - Zip Code:25880-6537
Mailing Address - Country:US
Mailing Address - Phone:304-356-0244
Mailing Address - Fax:
Practice Address - Street 1:3783 PACKS BRANCH RD
Practice Address - Street 2:
Practice Address - City:MOUNT HOPE
Practice Address - State:WV
Practice Address - Zip Code:25880-6537
Practice Address - Country:US
Practice Address - Phone:304-356-0244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant