Provider Demographics
NPI:1073366910
Name:CRUZ, DIANA MICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MICHELLE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ELSMERE AVE
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-2922
Mailing Address - Country:US
Mailing Address - Phone:978-788-3060
Mailing Address - Fax:
Practice Address - Street 1:365 EAST ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1950
Practice Address - Country:US
Practice Address - Phone:978-170-7535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2351045163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)