Provider Demographics
NPI:1205959111
Name:ABERNATHY, DIANE STEVENS
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:STEVENS
Last Name:ABERNATHY
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 1:7987 PEPPER PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2529
Mailing Address - Country:US
Mailing Address - Phone:513-777-0432
Mailing Address - Fax:
Practice Address - Street 1:7987 PEPPER PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2529
Practice Address - Country:US
Practice Address - Phone:513-777-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2690495Medicaid