Provider Demographics
NPI:1740699974
Name:SHARP, DIANA (LPN)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:SHARP
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:RISINGSUN
Mailing Address - State:OH
Mailing Address - Zip Code:43457-9776
Mailing Address - Country:US
Mailing Address - Phone:419-457-5343
Mailing Address - Fax:419-725-0676
Practice Address - Street 1:1010 N PROSPECT ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-1335
Practice Address - Country:US
Practice Address - Phone:419-352-5387
Practice Address - Fax:419-725-0676
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.120831-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse