Provider Demographics
NPI:1982404521
Name:CARROLL, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:CARROLL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53891 891 RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68718-4076
Mailing Address - Country:US
Mailing Address - Phone:402-841-7398
Mailing Address - Fax:
Practice Address - Street 1:53891 891 RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NE
Practice Address - Zip Code:68718-4076
Practice Address - Country:US
Practice Address - Phone:402-841-7398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide