Provider Demographics
NPI:1033450135
Name:PRIMERANO, DIANE (LPN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:PRIMERANO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 VINE ST
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-5230
Mailing Address - Country:US
Mailing Address - Phone:315-457-7392
Mailing Address - Fax:
Practice Address - Street 1:802 VINE ST
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-5230
Practice Address - Country:US
Practice Address - Phone:315-457-7392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268436-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse