Basic Information
| Provider Information | |||||||||
| NPI: | 1891756482 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARCIANO | ||||||||
| FirstName: | DIANNE | ||||||||
| MiddleName: | V. | ||||||||
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| Credential: | N.P., PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 ALEXANDER ST | ||||||||
| Address2: | STE 5000 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146074039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859228003 | ||||||||
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| Practice Location | |||||||||
| Address1: | 222 ALEXANDER ST | ||||||||
| Address2: | STE 5000 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146074039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859228003 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 01/27/2010 | ||||||||
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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 | 363LA2200X | 300488 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363A00000X | 000632 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 03052839 | 05 | NY | MEDICAID | P00249209 | 01 | NY | RAILROAD MEDICARE | OTHER |