Provider Demographics
NPI:1164881181
Name:LAVEGLIA, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:LAVEGLIA
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 1:803 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE KATRINE
Mailing Address - State:NY
Mailing Address - Zip Code:12449-5352
Mailing Address - Country:US
Mailing Address - Phone:845-331-5064
Mailing Address - Fax:
Practice Address - Street 1:803 GRANT AVE
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5352
Practice Address - Country:US
Practice Address - Phone:845-331-5064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY443825-1163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health