Provider Demographics
NPI:1043566292
Name:DUVIVIER, DIANA (NP-BC, DNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DUVIVIER
Suffix:
Gender:F
Credentials:NP-BC, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3702
Mailing Address - Country:US
Mailing Address - Phone:516-221-2123
Mailing Address - Fax:516-221-2124
Practice Address - Street 1:3408 PARK AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3702
Practice Address - Country:US
Practice Address - Phone:516-221-2123
Practice Address - Fax:516-221-2124
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305984363LA2200X
NY340836363LG0600X
NY403109363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology