Healthcare Provider Details

I. General information

NPI: 1952785990
Provider Name (Legal Business Name): DIANNE LYVERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2015
Last Update Date: 07/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 JOHNSTOWN RD SUITE 200
ELIZABETHTOWN KY
42701-3926
US

IV. Provider business mailing address

1002 JOHNSTOWN RD SUITE 200
ELIZABETHTOWN KY
42701-3926
US

V. Phone/Fax

Practice location:
  • Phone: 270-735-1690
  • Fax:
Mailing address:
  • Phone: 270-735-1690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number3009227
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: