Provider Demographics
NPI:1083248991
Name:LEVY, DIANA P (MSN, MBA, CRNA, APRN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:P
Last Name:LEVY
Suffix:
Gender:F
Credentials:MSN, MBA, CRNA, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARSLBAD MEDICAL CENTER
Mailing Address - Street 2:2430 W PIERCE ST.
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220
Mailing Address - Country:US
Mailing Address - Phone:575-887-4100
Mailing Address - Fax:575-887-4531
Practice Address - Street 1:CARLSBAD MEDICAL CENTER
Practice Address - Street 2:2430 W PIERCE ST.
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220
Practice Address - Country:US
Practice Address - Phone:575-887-4100
Practice Address - Fax:575-887-4531
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-29
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0002126-C-CRNA367500000X
FLAPRN11007353367500000X
NM61201367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered