Individual
DIANE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
175 PHILPOT LANE, BEAVER, WV 25813
(304) 254-9262
Mailing address
PO BOX 274, GLEN JEAN, WV 25846-0274
(304) 469-2652
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
27398
WV
Other
Enumeration date
05/17/2007
Last updated
07/08/2007
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