Healthcare Provider Details

I. General information

NPI: 1487859641
Provider Name (Legal Business Name): DIANA LYNN STAPLETON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5286 PHILLIPSBURG UNION RD
UNION OH
45322-9732
US

IV. Provider business mailing address

5286 PHILLIPSBURG UNION RD
UNION OH
45322-9732
US

V. Phone/Fax

Practice location:
  • Phone: 937-836-8548
  • Fax:
Mailing address:
  • Phone: 937-836-8548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number165813
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: