Provider Demographics
NPI:1003221326
Name:YACIUK, DIANE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:YACIUK
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N WASHINGTON ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-1299
Mailing Address - Country:US
Mailing Address - Phone:315-867-1176
Mailing Address - Fax:315-867-1612
Practice Address - Street 1:301 N WASHINGTON ST STE 2300
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1299
Practice Address - Country:US
Practice Address - Phone:315-867-1176
Practice Address - Fax:315-867-1612
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY481275163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health