Basic Information
| Provider Information | |||||||||
| NPI: | 1811075260 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEEPER | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N, | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 LEEPER RD | ||||||||
| Address2: | |||||||||
| City: | OKOLONA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719629773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703792092 | ||||||||
| FaxNumber: | 8703792311 | ||||||||
| Practice Location | |||||||||
| Address1: | 1420 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HOPE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 718017243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707774848 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R70804 | AR | Y | Nursing Service Providers | Registered Nurse |
No ID Information.