Provider Demographics
NPI:1568627743
Name:VEGA, DIANA L (LPN)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:L
Last Name:VEGA
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 1:1728 CHURCHILL DOWNS RD APT A
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3289
Mailing Address - Country:US
Mailing Address - Phone:740-366-7497
Mailing Address - Fax:
Practice Address - Street 1:1728 CHURCHILL DOWNS RD
Practice Address - Street 2:APT A
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3288
Practice Address - Country:US
Practice Address - Phone:740-366-7497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-27
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN041723164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse