Healthcare Provider Details

I. General information

NPI: 1184544934
Provider Name (Legal Business Name): DIANNA BURNS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 LANE 101F JIMMERSON LK LOT A7
ANGOLA IN
46703-8316
US

IV. Provider business mailing address

40 LANE 101F JIMMERSON LK LOT A7
ANGOLA IN
46703-8316
US

V. Phone/Fax

Practice location:
  • Phone: 260-402-9093
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704451670
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: