Provider Demographics
NPI:1386932234
Name:PRZYMUS, DIANE (BA)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:PRZYMUS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-0746
Mailing Address - Country:US
Mailing Address - Phone:763-331-1449
Mailing Address - Fax:
Practice Address - Street 1:224 RIVER ST N
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-8260
Practice Address - Country:US
Practice Address - Phone:763-331-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist