Provider Demographics
NPI:1154545457
Name:NIPPER, DIANE MARIE (RN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:NIPPER
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 1:1207 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-1140
Mailing Address - Country:US
Mailing Address - Phone:440-593-2373
Mailing Address - Fax:440-599-2181
Practice Address - Street 1:1207 LAKE RD
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-1140
Practice Address - Country:US
Practice Address - Phone:440-593-2373
Practice Address - Fax:440-599-2181
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 247658163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2106170Medicaid