Provider Demographics
NPI:1588349104
Name:BLEVINS, DIANA JANE (LVN)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:JANE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50173 CALLE MARBELLA
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-5542
Mailing Address - Country:US
Mailing Address - Phone:760-393-9000
Mailing Address - Fax:
Practice Address - Street 1:50173 CALLE MARBELLA
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-5542
Practice Address - Country:US
Practice Address - Phone:760-393-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA721982164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse