Basic Information
| Provider Information | |||||||||
| NPI: | 1972852069 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DILES | ||||||||
| FirstName: | APRIL | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | FPMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7550 S STATE STREET | ||||||||
| Address2: | NORTH COUNTRY TRANSITIONAL LIVING SERVICES INC | ||||||||
| City: | LOWVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133671533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153765450 | ||||||||
| FaxNumber: | 3153767221 | ||||||||
| Practice Location | |||||||||
| Address1: | 7550 S STATE STREET | ||||||||
| Address2: | NORTH COUNTRY TRANSITIONAL LIVING SERVICES INC | ||||||||
| City: | LOWVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133671533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153765450 | ||||||||
| FaxNumber: | 3153767221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2012 | ||||||||
| LastUpdateDate: | 04/04/2016 | ||||||||
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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 | 363LP0808X | 401513 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 03685581 | 05 | NY | MEDICAID | 401513 | 01 | NY | NURSE PRACTITIONER LICENSE NUMBER | OTHER |