Provider Demographics
NPI:1306990346
Name:SZLACHETKA, DIANE M (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:M
Last Name:SZLACHETKA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 MOUNTAIN ESTS
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:VT
Mailing Address - Zip Code:05655-4442
Mailing Address - Country:US
Mailing Address - Phone:802-888-3639
Mailing Address - Fax:
Practice Address - Street 1:292 MOUNTAIN ESTS
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:VT
Practice Address - Zip Code:05655-4442
Practice Address - Country:US
Practice Address - Phone:802-888-3639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA166641363LN0005X
VT101.0084113363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care