Provider Demographics
NPI:1992020879
Name:NAAN, DIANE LEE (LMT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LEE
Last Name:NAAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CAMINO DEL SOL
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-5705
Mailing Address - Country:US
Mailing Address - Phone:505-620-3000
Mailing Address - Fax:
Practice Address - Street 1:3409 STATE HIGHWAY 47
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-6336
Practice Address - Country:US
Practice Address - Phone:505-620-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3019225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist