Provider Demographics
NPI:1215157565
Name:RZEPKOWSKI, DIANE RENE (LPN)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:RENE
Last Name:RZEPKOWSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6459 LACROSSE LN NE
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-8823
Mailing Address - Country:US
Mailing Address - Phone:410-766-1328
Mailing Address - Fax:
Practice Address - Street 1:210 CENTRAL AVE E
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037
Practice Address - Country:US
Practice Address - Phone:410-956-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP21970164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse