Provider Demographics
NPI:1184858482
Name:ELVIN, DIANE ANDREA
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:ANDREA
Last Name:ELVIN
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 1:62 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4510
Mailing Address - Country:US
Mailing Address - Phone:201-820-3001
Mailing Address - Fax:
Practice Address - Street 1:62 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4510
Practice Address - Country:US
Practice Address - Phone:201-820-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ296741164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse