Provider Demographics
NPI:1982218194
Name:DIAMOND, JENNIFER MAE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MAE
Last Name:DIAMOND
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 1:53 REED ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-1169
Mailing Address - Country:US
Mailing Address - Phone:304-236-5002
Mailing Address - Fax:
Practice Address - Street 1:53 REED ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-1169
Practice Address - Country:US
Practice Address - Phone:304-236-5002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant