Provider Demographics
NPI:1811515810
Name:JEWELL, DIANNA S
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:S
Last Name:JEWELL
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 1:3002 COUNTY ROAD 377
Mailing Address - Street 2:
Mailing Address - City:KOSHKONONG
Mailing Address - State:MO
Mailing Address - Zip Code:65692-7880
Mailing Address - Country:US
Mailing Address - Phone:417-655-4501
Mailing Address - Fax:
Practice Address - Street 1:3002 COUNTY ROAD 377
Practice Address - Street 2:
Practice Address - City:KOSHKONONG
Practice Address - State:MO
Practice Address - Zip Code:65692-7880
Practice Address - Country:US
Practice Address - Phone:417-655-4501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider