Provider Demographics
NPI:1972258960
Name:SCHLAACK, DIANA (RN)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:SCHLAACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 W M 21 STE B
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-9317
Mailing Address - Country:US
Mailing Address - Phone:989-720-4961
Mailing Address - Fax:989-720-4951
Practice Address - Street 1:1905 W M 21 STE B
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9317
Practice Address - Country:US
Practice Address - Phone:989-720-4961
Practice Address - Fax:989-720-4951
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704298857163W00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No163W00000XNursing Service ProvidersRegistered Nurse