Provider Demographics
NPI:1770980435
Name:DIMOND, RANDY (LPN)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:DIMOND
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 S WAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3275
Mailing Address - Country:US
Mailing Address - Phone:509-430-5668
Mailing Address - Fax:
Practice Address - Street 1:33 S WAVERLY ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3275
Practice Address - Country:US
Practice Address - Phone:509-430-5668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00047844164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse