Provider Demographics
NPI:1457900805
Name:AUSTIN, DIAMOND LESHAWN (RN)
Entity Type:Individual
Prefix:
First Name:DIAMOND
Middle Name:LESHAWN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 BOYD RD
Mailing Address - Street 2:
Mailing Address - City:BRONSON
Mailing Address - State:TX
Mailing Address - Zip Code:75930-5800
Mailing Address - Country:US
Mailing Address - Phone:936-596-8233
Mailing Address - Fax:
Practice Address - Street 1:660 BOYD RD
Practice Address - Street 2:
Practice Address - City:BRONSON
Practice Address - State:TX
Practice Address - Zip Code:75930-5800
Practice Address - Country:US
Practice Address - Phone:936-596-8233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX948405163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse