Healthcare Provider Details

I. General information

NPI: 1104029644
Provider Name (Legal Business Name): DIANA HANDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 REDWOOD DR
PENDLETON IN
46064-9263
US

IV. Provider business mailing address

560 REDWOOD DR
PENDLETON IN
46064-9263
US

V. Phone/Fax

Practice location:
  • Phone: 765-778-8292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number28087242A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: