Provider Demographics
NPI:1316320708
Name:DIAZ, NELLY E (DOULA)
Entity type:Individual
Prefix:MRS
First Name:NELLY
Middle Name:E
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-1111
Mailing Address - Country:US
Mailing Address - Phone:908-374-9288
Mailing Address - Fax:
Practice Address - Street 1:626 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204-1111
Practice Address - Country:US
Practice Address - Phone:908-374-9288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula