Provider Demographics
NPI:1114606043
Name:DITOMASSO, DIANE J
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:J
Last Name:DITOMASSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-8416
Mailing Address - Country:US
Mailing Address - Phone:401-284-6857
Mailing Address - Fax:
Practice Address - Street 1:11 11TH AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-8416
Practice Address - Country:US
Practice Address - Phone:401-284-6857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILLC00078163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant