Basic Information
| Provider Information | |||||||||
| NPI: | 1801201777 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELLA PORTA | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1208 DRIVING PARK AVE | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145131057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153592640 | ||||||||
| FaxNumber: | 3153592645 | ||||||||
| Practice Location | |||||||||
| Address1: | 1208 DRIVING PARK AVE | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145131057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153592640 | ||||||||
| FaxNumber: | 3153592645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2014 | ||||||||
| LastUpdateDate: | 06/30/2014 | ||||||||
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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 | 471946-1 | NY | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | NA | 01 | NONE | OTHER |