Provider Demographics
NPI:1538354618
Name:SOARES, DIANTHA JEANNE (LPN)
Entity type:Individual
Prefix:MS
First Name:DIANTHA
Middle Name:JEANNE
Last Name:SOARES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4703 US NORTH 31
Mailing Address - Street 2:
Mailing Address - City:KEWADIN
Mailing Address - State:MI
Mailing Address - Zip Code:49648
Mailing Address - Country:US
Mailing Address - Phone:231-463-0380
Mailing Address - Fax:
Practice Address - Street 1:4703 US NORTH 31
Practice Address - Street 2:
Practice Address - City:KEWADIN
Practice Address - State:MI
Practice Address - Zip Code:49648
Practice Address - Country:US
Practice Address - Phone:231-463-0380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703089304164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse