Provider Demographics
NPI:1043807159
Name:COUNTS, DIANNA
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:COUNTS
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 1:8148 AMESBURY CANYON ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4650
Mailing Address - Country:US
Mailing Address - Phone:702-372-0470
Mailing Address - Fax:
Practice Address - Street 1:8148 AMESBURY CANYON ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4650
Practice Address - Country:US
Practice Address - Phone:702-372-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2024-02-07
Deactivation Date:2023-06-02
Deactivation Code:
Reactivation Date:2024-01-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA212306201Medicaid