Provider Demographics
NPI:1932965217
Name:DIANE'S FULL SPECTRUM DOULA SUPPORT LLC
Entity Type:Organization
Organization Name:DIANE'S FULL SPECTRUM DOULA SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:ELEANOR
Authorized Official - Last Name:SLUUS
Authorized Official - Suffix:
Authorized Official - Credentials:CD
Authorized Official - Phone:518-322-5058
Mailing Address - Street 1:59 MOUNTAINVIEW TER
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-9725
Mailing Address - Country:US
Mailing Address - Phone:518-322-5058
Mailing Address - Fax:
Practice Address - Street 1:59 MOUNTAINVIEW TER
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-9725
Practice Address - Country:US
Practice Address - Phone:518-322-5058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty