Provider Demographics
NPI:1932781275
Name:NEWELL, DIANTE NATHANIEL
Entity Type:Individual
Prefix:
First Name:DIANTE
Middle Name:NATHANIEL
Last Name:NEWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 ALVIS RD
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:VA
Mailing Address - Zip Code:23950-2012
Mailing Address - Country:US
Mailing Address - Phone:434-917-2628
Mailing Address - Fax:
Practice Address - Street 1:818 ALVIS RD
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:VA
Practice Address - Zip Code:23950-2012
Practice Address - Country:US
Practice Address - Phone:434-917-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)