Provider Demographics
NPI:1831763788
Name:AUSTIN, DIANE C (RN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3386 WOODVALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-8794
Mailing Address - Country:US
Mailing Address - Phone:810-656-5124
Mailing Address - Fax:
Practice Address - Street 1:2770 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLETTE
Practice Address - State:MI
Practice Address - Zip Code:48453-1141
Practice Address - Country:US
Practice Address - Phone:989-635-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-16
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704235636163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice