Provider Demographics
NPI:1932383791
Name:BRENNER, DIANE LUCILLE (LPN)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LUCILLE
Last Name:BRENNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:SNYDER
Other - Last Name:BRENNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:503 DESMOND ST
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840
Mailing Address - Country:US
Mailing Address - Phone:570-888-3893
Mailing Address - Fax:
Practice Address - Street 1:60 SARATOGA AVE
Practice Address - Street 2:5 20
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903
Practice Address - Country:US
Practice Address - Phone:607-331-9994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPN1934281164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse