Provider Demographics
NPI:1255758900
Name:WEBB, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:WEBB
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 1:15724 STATE ROUTE 550
Mailing Address - Street 2:
Mailing Address - City:FLEMING
Mailing Address - State:OH
Mailing Address - Zip Code:45729-5065
Mailing Address - Country:US
Mailing Address - Phone:740-374-9745
Mailing Address - Fax:
Practice Address - Street 1:15724 STATE ROUTE 550
Practice Address - Street 2:
Practice Address - City:FLEMING
Practice Address - State:OH
Practice Address - Zip Code:45729-5065
Practice Address - Country:US
Practice Address - Phone:740-374-9745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1450246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other