Provider Demographics
NPI:1700586864
Name:MOHLER, DIANE LYNN
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LYNN
Last Name:MOHLER
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 1:1090 DICKERSON DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-3982
Mailing Address - Country:US
Mailing Address - Phone:937-216-6025
Mailing Address - Fax:
Practice Address - Street 1:1090 DICKERSON DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3982
Practice Address - Country:US
Practice Address - Phone:937-216-6025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0000164423251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000164423Medicaid
OH5501933Medicaid