Provider Demographics
NPI:1528295979
Name:WOLFF, DIANNE (NP)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:WOLFF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 VIOLET AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1034
Mailing Address - Country:US
Mailing Address - Phone:845-471-1807
Mailing Address - Fax:845-471-1815
Practice Address - Street 1:370 VIOLET AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1034
Practice Address - Country:US
Practice Address - Phone:845-471-1807
Practice Address - Fax:845-471-1815
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY505770163W00000X
NY401868363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000400508001OtherBSNENY
NY337050OtherMEDICARE A
NYWZZYW1OtherMEDICARE B
NY00473230Medicaid
NY004394OtherEMPIRE BC