Diamond Commodore, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

163571 Issued in OH

Practice address

73 Bishopsgate Dr Apt 306
Cincinnati, OH 45246-4362

Phone

(513) 485-2513

NPI assigned

Dec 12, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639267200000",
    "number": "1811656317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73 BISHOPSGATE DR APT 306",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452464362",
            "telephone_number": "513-485-2513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73 BISHOPSGATE DR APT 306",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452464362",
            "telephone_number": "513-485-2513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COMMODORE",
        "first_name": "DIAMOND",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-12",
        "last_updated": "2021-12-12",
        "certification_date": "2021-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "163571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE PAY",
            "identifier": "163571",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Licensed Practical Nurse in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.