Provider Demographics
NPI:1760219646
Name:ROPER, WANIQUE DIAMOND (LPN)
Entity type:Individual
Prefix:MS
First Name:WANIQUE
Middle Name:DIAMOND
Last Name:ROPER
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 1:8023 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4315
Mailing Address - Country:US
Mailing Address - Phone:513-780-6044
Mailing Address - Fax:
Practice Address - Street 1:813 TROY ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1852
Practice Address - Country:US
Practice Address - Phone:937-982-1500
Practice Address - Fax:937-982-1600
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH189678164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty