Provider Demographics
NPI:1386065613
Name:REID, DIANA LYNN (LPN)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:REID
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 1:738 COOKE ST
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978-1005
Mailing Address - Country:US
Mailing Address - Phone:352-428-6010
Mailing Address - Fax:631-998-0997
Practice Address - Street 1:738 COOKE ST
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-1005
Practice Address - Country:US
Practice Address - Phone:635-428-6010
Practice Address - Fax:631-998-0997
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316483164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse