Provider Demographics
NPI:1528496932
Name:BLACK, DIANAH J (LPN)
Entity type:Individual
Prefix:
First Name:DIANAH
Middle Name:J
Last Name:BLACK
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 1:830 HARBOR PL
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:OH
Mailing Address - Zip Code:45067-1087
Mailing Address - Country:US
Mailing Address - Phone:513-649-5435
Mailing Address - Fax:
Practice Address - Street 1:830 HARBOR PL
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:OH
Practice Address - Zip Code:45067-1087
Practice Address - Country:US
Practice Address - Phone:513-649-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141565164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse