Provider Demographics
NPI:1104071398
Name:ABBOTT, DIANE ALIDA (RN, CWON, MSN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:ALIDA
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:RN, CWON, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 DEL ROY DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-1452
Mailing Address - Country:US
Mailing Address - Phone:512-699-6511
Mailing Address - Fax:
Practice Address - Street 1:1210 DEL ROY DR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-1452
Practice Address - Country:US
Practice Address - Phone:512-699-6511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX656130163WE0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy