Individual
REUBEN DIACHENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
CORNER OF ROUTES N12 & N7, FORT DEFIANCE, AZ 86504
(928) 729-8600
Mailing address
1887 WHITNEY MESA DR # 2676, HENDERSON, NV 89014-2069
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
211930
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
211930
SOUTH CAROLINA STATE BOARD OF NURSING (COMPACT LICENSE)
SC
Enumeration date
11/22/2022
Last updated
11/23/2022
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