Provider Demographics
NPI:1073381216
Name:DIBELLA, ANITA MARIA (RN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIA
Last Name:DIBELLA
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 1:8616 PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-3453
Mailing Address - Country:US
Mailing Address - Phone:716-440-8138
Mailing Address - Fax:
Practice Address - Street 1:8616 PERSHING AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-3453
Practice Address - Country:US
Practice Address - Phone:716-440-8138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY542940163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse