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General NPI Number Information
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NPI Number | 1962388330
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Entity Type | Individual
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Provider Name | DIANE JOYCE ROARK ACAG-NP
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Gender | Female
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 09/15/2026
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Provider Practice Location Address
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Address Line | 130 S BROADWAY AVE
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City | SALEM
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State | OH
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Zip | 44460-3002
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Country | US
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Telephone | 220-270-6900
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Fax |
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Provider Business Mailing Address
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Address Line | 6859 FAIRGROUND BLVD
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City | CANFIELD
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State | OH
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Zip | 44406-1550
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Country | US
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Telephone | 916-365-3590
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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 | RN420692
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APRN.CNP.0039994
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License Number State | OH
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