Provider Demographics
NPI:1528461688
Name:ELLIOTT, DIANE GAYLE (LPN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:GAYLE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:GAYLE
Other - Last Name:HUTCHESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3253 CREEK RD
Mailing Address - Street 2:LOT 159
Mailing Address - City:NEW WATERFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44445-9600
Mailing Address - Country:US
Mailing Address - Phone:330-397-7973
Mailing Address - Fax:
Practice Address - Street 1:3253 CREEK RD
Practice Address - Street 2:LOT 159
Practice Address - City:NEW WATERFORD
Practice Address - State:OH
Practice Address - Zip Code:44445-9600
Practice Address - Country:US
Practice Address - Phone:330-397-7973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 082333-M-IV164X00000X
PAPN298708164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse