Provider Demographics
NPI:1770741043
Name:NEVILLE, DIANE HODGES (RN,BSN)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:HODGES
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 W ALTMAN ST
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5277
Mailing Address - Country:US
Mailing Address - Phone:912-764-6129
Mailing Address - Fax:912-489-4480
Practice Address - Street 1:4 W ALTMAN ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5277
Practice Address - Country:US
Practice Address - Phone:912-764-6129
Practice Address - Fax:912-489-4480
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN049787163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator