Individual
DIANNA FORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
111 LOVETT DR, GREENVILLE, SC 29607-6510
(801) 869-4100
Mailing address
1440 PARK TER, MOORE, SC 29369-8307
(757) 952-9974
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
28250
SC
Other
Enumeration date
01/10/2024
Last updated
01/10/2024
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