Provider Demographics
NPI:1538766969
Name:PONDER, DIANE ARLENE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:ARLENE
Last Name:PONDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 REID AVE
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-2748
Mailing Address - Country:US
Mailing Address - Phone:937-750-5938
Mailing Address - Fax:
Practice Address - Street 1:1430 REID AVE
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2748
Practice Address - Country:US
Practice Address - Phone:937-750-5938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care