Provider Demographics
NPI:1902912413
Name:RAND, DIANNE C (FNP AND LISW)
Entity type:Individual
Prefix:PROF
First Name:DIANNE
Middle Name:C
Last Name:RAND
Suffix:
Gender:F
Credentials:FNP AND LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2449 HIAWATHA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1921
Mailing Address - Country:US
Mailing Address - Phone:505-275-8212
Mailing Address - Fax:
Practice Address - Street 1:2449 HIAWATHA DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1921
Practice Address - Country:US
Practice Address - Phone:505-275-8212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-055081041C0700X
NMR09241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical