Provider Demographics
NPI:1669004446
Name:FERN, DIANA (CPM)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:FERN
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 KALE BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-8871
Mailing Address - Country:US
Mailing Address - Phone:641-919-4903
Mailing Address - Fax:
Practice Address - Street 1:2325 KALE BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-8871
Practice Address - Country:US
Practice Address - Phone:641-919-4903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay