Provider Demographics
NPI:1386700607
Name:PLUMADORE, DIANE M (FNP NPP)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:M
Last Name:PLUMADORE
Suffix:
Gender:F
Credentials:FNP NPP
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:M
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN FNP
Mailing Address - Street 1:742 JAMES STREET
Mailing Address - Street 2:ST JOSEPHS HOSPITAL HEALTH CENTER MENTAL HEALTH CENTER
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203
Mailing Address - Country:US
Mailing Address - Phone:315-703-2700
Mailing Address - Fax:315-703-2730
Practice Address - Street 1:742 JAMES STREET
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203
Practice Address - Country:US
Practice Address - Phone:315-703-2700
Practice Address - Fax:315-703-2730
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330063363LF0000X
NYF400548363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400048586Medicare PIN
R55841Medicare UPIN
NYRA9366Medicare PIN