Healthcare Provider Details

I. General information

NPI: 1174693477
Provider Name (Legal Business Name): DIANE ALBRIGHT LM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 CENTER POINTE CIR BLD 401 SUITE 1537
ALTAMONTE SPRINGS FL
32701-3459
US

IV. Provider business mailing address

4622 DONOVAN ST
ORLANDO FL
32808-2710
US

V. Phone/Fax

Practice location:
  • Phone: 407-265-9787
  • Fax: 407-265-9788
Mailing address:
  • Phone: 407-257-6514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberMW113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: