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General NPI Number Information
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NPI Number | 1891184032
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Entity Type | Individual
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Provider Name | LADEANA DIVER
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Gender | Female
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 312 BAKER STREET
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City | PITSBURG
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State | OH
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Zip | 45358-1260
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Country | US
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Telephone | 937-875-7085
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Fax |
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Provider Business Mailing Address
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Address Line | 312 BAKER ST
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City | PITSBURG
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State | OH
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Zip | 45358-5049
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Country | US
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Telephone | 937-875-7085
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN281361
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License Number State | OH
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