Healthcare Provider Details

I. General information

NPI: 1003105248
Provider Name (Legal Business Name): DIANA LYNN GEDEON RN, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYNN GEDEON RN, LSW

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16922 S CANAAN RD
ATHENS OH
45701-9461
US

IV. Provider business mailing address

16922 S CANAAN RD
ATHENS OH
45701-9461
US

V. Phone/Fax

Practice location:
  • Phone: 740-592-6074
  • Fax: 740-592-6074
Mailing address:
  • Phone: 740-592-6074
  • Fax: 740-592-6074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN307502
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: