Provider Demographics
NPI:1336434844
Name:PORCELLO, DIANE PATRICIA (RN)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:PATRICIA
Last Name:PORCELLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 SADDLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4833
Mailing Address - Country:US
Mailing Address - Phone:631-337-1934
Mailing Address - Fax:631-337-1934
Practice Address - Street 1:2602 SADDLE ROCK RD
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4833
Practice Address - Country:US
Practice Address - Phone:631-337-1934
Practice Address - Fax:631-337-1934
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298096163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice