Individual
DIAMOND COMMODORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
73 BISHOPSGATE DR APT 306, CINCINNATI, OH 45246-4362
(513) 485-2513
Mailing address
73 BISHOPSGATE DR APT 306, CINCINNATI, OH 45246-4362
(513) 485-2513
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
163571
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
163571
PRIVATE PAY
OH
Enumeration date
12/12/2021
Last updated
12/12/2021
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