Individual
DIANE GAYLE ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3253 CREEK RD, LOT 159, NEW WATERFORD, OH 44445-9600
(330) 397-7973
Mailing address
3253 CREEK RD, LOT 159, NEW WATERFORD, OH 44445-9600
(330) 397-7973
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
PN298708
PA
164X00000X
Licensed Vocational Nurse
Primary
PN 082333-M-IV
OH
Other
Enumeration date
10/03/2014
Last updated
10/16/2014
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