Provider Demographics
NPI:1902166507
Name:PETERS, DIANE LOUISE (RN)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LOUISE
Last Name:PETERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 SHADY NOOK CT
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1149
Mailing Address - Country:US
Mailing Address - Phone:410-437-9267
Mailing Address - Fax:
Practice Address - Street 1:8220 SHADY NOOK CT
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1149
Practice Address - Country:US
Practice Address - Phone:410-437-9267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR 119157163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse