Healthcare Provider Details

I. General information

NPI: 1043084916
Provider Name (Legal Business Name): DIANE MARIE DIMOLA MPH, RN, BSN, CPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

7809 JEFFERSON OAKS DR
KNOXVILLE TN
37938-4446
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9000
  • Fax:
Mailing address:
  • Phone: 609-439-1809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number258595
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number258595
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number258595
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: