Healthcare Provider Details

I. General information

NPI: 1689990418
Provider Name (Legal Business Name): DIANNA LYNNE HOBART LPN IV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MAROY DR.
SOUTH AMHERST OH
44001-2840
US

IV. Provider business mailing address

118 MAROY DR.
SOUTH. AMHERST OH
44001-2840
US

V. Phone/Fax

Practice location:
  • Phone: 440-986-2115
  • Fax:
Mailing address:
  • Phone: 440-986-2115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN. 120271 IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: