Provider Demographics
NPI:1811124118
Name:DAVENPORT, DIANE LORRAINE (LPN)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LORRAINE
Last Name:DAVENPORT
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 1:737 CRANE WALK
Mailing Address - Street 2:APT D
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-2290
Mailing Address - Country:US
Mailing Address - Phone:330-957-0625
Mailing Address - Fax:
Practice Address - Street 1:737 CRANE WALK
Practice Address - Street 2:APT D
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-2290
Practice Address - Country:US
Practice Address - Phone:330-957-0625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 083149164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse